Background & Objective: Spinal anesthesia is one of the usual techniques in the surgery of hip fractures among the aged. On the other hand the hemodynamic complications of this method and the treatment of these complications by abundant Ir liquids and drugs such as Ephedrin and phenylephedrin have potential risk for aged patients. Intrathecal opioids have synergistic effects on the duration and quality of spinal block. Thus a number of efforts have been made to prevent the hemodynamic complications and probability of inadequate block by decreasing the dosage of local anesthetic drug and adding opioid drugs to it. This study investigates the hemodynamic effects and the quality of spinal anesthesia using the above-mentioned method.

  Methods: Forty-six patients above 60 years of age with hip fracture were randomized into 2 groups (A and B). Group A received a spinal of hyper tonic bupivacaine (5 mg) and fentanyl (20 m g) and group B received 12.5 mg of hypertonic bupivacaine for spinal anesthesia. Vital signs before and during the surgery, quality and quantity of blockage, amount of fluid and Ephedrine used, were recorded every 5 minutes.

  Results: MAP (Mean Arterial Pressure) fall and the dosage and frequency of ephedrine consumption were significantly different in two groups. MAP decrease in-group A was 23.6 ± 10.79 and in-group B it was 36 ± 11.1 (p=0.001). The average requirement of ephedrine in the groups were 2.25 ± 3.49 mg in-group A and 10 ± 8.45 mg in-group B (P=0.001). The average occurrence of hypotension and ephedrine usage was 0.71 ± 1.08 times in-group A and 2.91 ± 2.94 times in-group B (p=0.001). 29 % of group A had pain in the terminal stage of surgery but this amount in-group B was 13.6%. Tachycardia was 29.2 % in-group A and 68.2 % in group B (p=0.001).

  Conclusions: Adding 20 m g fentanyl to bupivacaine and decreasing its dosage can prevent the complications of intrathecal anesthesia. (MAP fall and the tachycardia occurred in the process of its treatment) to a great extent. But to lower the incidence of failure and obtain reliable block, more controlled studies must be accomplished.

  Background & objectives: Eisenmenger syndrome associated with pregnancy increases the maternal morbidity and mortality . Therefore, in the most of such patients the termination of pregnancy is recommended.

  Case report: A 29 -year-old woman at the 7 ^th week of gestational age was candidate for therapeutic abortion with history of Eisenmenger syndrome due to atrial septal defect (ASD) . Spinal a nesthesia was performed in sitting position at the L4-5 interspace with 10 mg of bupivacaine . The p atient was laid in the supine position after 2 minutes. The surgery lasted about an hour . Blood pressure and heart rate did not change significantly during operation.

  Conclusion : Modified s pinal anesthesia with bupivacaine is recommended for therapeutic abortion in patients with Eisenmenger syndrome.