Frequency of hypotension and bradycardia during general anesthesia, epidural anesthesia, or integrated epidural-general anesthesia for total hip replacement

Study Objective: To evaluate the frequency of hypotension and bradycardia during integrated epidural-general anesthesia as compared with general anesthesia or epidural anesthesia alone. Design: Prospective, randomized, open, multicenter study Setting: Inpatient anesthesia at 7 University or Hospital Departments of anesthesia. Patients: 210 ASA physical status I, II, and III patients undergoing elective total hip replacement. Interventions: Using a balanced randomization method, each hospital enrolled 30 (consecutive patients who received integrated epidural-general anesthesia, epidural anesthesia, or general anesthesia. Measurements and Main Results: Occurrence of clinically relevant hypotension (systolic arterial blood pressure (BP) decrease >30% front baseline), or brad cardia (heart rate (HR) <45 bpm) requiring pharmacologic treatment were recorded, I as well as routine cardiovascular parameters. Clinically relevant hypotension during induction of nerve block was reported in 13 patients receiving epidural block (18%) and 16 patients receiving epidural-general anesthesia (22%) (p = 0.67). Subsequently, 22 of the remaining 54 Patients in the epidural-general anesthesia group (41%) developed hypotension after the induction of general anesthesia, as compared with 16 Patients of the general anesthesia group (23%) (p = 0.049). No differences in HR or in frequency of bradycardia were observed in the three groups. Conclusions: The induction of general anesthesia in patients with an epidural block up to T-10 increased the odds of developing clinically relevant hypotension as compared with those patients who received no epidural block, and was associated with a twofold increase of the odds of hypotension as compared with the use of epidural anesthesia alone. (C) 2002 by Elsevier Science Inc.