Abstract: Objective To observe the hemodynamic effects of combined spinal-epidural(CSE) anesthesia in 75 years or older patients. Methods In a prospective study, 40 American Society of Anesthesiologists (ASA) Ⅱ-Ⅲ patients(aged 75 years or older), undergoing elective total knee replacement(TKR) surgery were randomly assigned to either CSE anesthesia(CSEA, n=20) or epidural anesthesia alone(EA, n=20). Hemodynamic measurements included invasive mean arterial blood pressure(MAP) and heart rate(HR). The primary endpoint (outcome) was the number of hypotension and bradycardic episodes(defined as MAP<70 mmHg and HR<50 bpm). Results On univariate analysis, no significant differences between the groups with regards to MAP and HR during the perioperative period. The incidence of hypotension was similar between both groups(two patients in each group), as was the incidence of bradycardia(12 patients in CSE, 7 in EA groups; P=0.20). Conclusion Combined spinal-epidural anesthesia and epidural anesthesia alone during TKR surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.

Key words: hemodynamics, combined spinal-epidural anesthesia, elderly patients