Dexamethasone, Urologic Endoscopic Surgery
Conditions
Brief summary
Correction of Post-spinal anesthesia hypotension by fluids pose the risk of volume overload or compromising cardiac conditions. Intravenous Dexamethasone in some studies is used to treat conditions manifested by decrease of peripheral vascular resistance Many advantages were investigated for the addition of dexamethasone to bupivacaine in spinal anesthesia as prolongation of anesthesia time, postoperative analgesia and prophylaxis for shivering. In this study the investigators will investigate the ability of dexamethasone to blunt post-spinal anesthesia hypotension in elderly patients undergoing urological endoscopic surgery, and hence, if it decreases amount of fluids and dose of vasoactive drugs.
Detailed description
Spinal anesthesia is the most consistent block for lower abdomen and lower limb surgery. Spinal anesthesia avoids the risks of general anesthesia such as aspiration of gastric contents and difficulty with airway management. Post-spinal anesthesia hypotension in elderly patients is challenging. Correction of Post-spinal anesthesia hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Intravenous Dexamethasone in some studies is used to treat conditions manifested by decrease of peripheral vascular resistance. Many advantages were investigated for the addition of dexamethasone to bupivacaine in spinal anesthesia as prolongation of anesthesia time, postoperative analgesia and prophylaxis for shivering. Avoidance of complications of opioids is a great issue as, postoperative nausea, vomiting, respiratory depression, urinary retention, prolonged hospital stay and immunosuppression. In this study the investigators will investigate the ability of dexamethasone to blunt post-spinal anesthesia hypotension in elderly patients undergoing urological endoscopic surgery, and hence, if it decreases amount of fluids and dose of vasoactive drugs.
Interventions
DRUGDexamethasone
8 mg intrathecally
DRUGBupivacaine Hydrochloride
0.5 % intrathecally
Sponsors
Assiut University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
60 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
* Age: \> 60 years old * Gender: Males and females * ASA grade I - II - III * Patients undergoing elective endoscopic urological procedures.
Exclusion criteria
* Patient refusal. * Suspected massive bleeding. * Transition to open abdominal surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total amount of fluids | intraoperative | Total amount of fluids needed to maintain mean blood pressure more than 65 mmHg |
| Total amount of vasoactive drugs | Intraoperative | Total amount of vasoactive drugs needed to maintain mean blood pressure more than 65 mmHg |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post-operative shivering. | Up to 6 hours postoperatively. | shivering of the patient |
| Blood pressure | Intraoperative and up to 1hour postoperative | systolic and diastolic blood pressure and mean arterial blood pressure. |
| Post dural puncture headache. | Up to 2 days postoperative | headache during 2 days postoperative and detection of severity and response to treatment |
| Post-operative nausea and vomiting. | Up to 6 hours postoperatively. | The presence of nausea or vomiting 6 hours post operatively |
| Post-operative VAS score of pain assessment. | Up to one hour postoperative | Scores are based on self-reported measures of symptoms that are recorded with a single handwritten mark placed at one point along the length of a 10-cm line that represents a continuum between the two ends of the scale-no pain on the left end (0 cm) of the scale and the worst pain on the right end of the scale (10 cm). |
Outcome results
None listed