Hemodynamic effect of epidurally administered epinephrine in middle-aged and elderly patients

The circulatory effects of epinephrine, added to local anesthetic, during epidural analgesia were compared between middle-aged (52-65 years) and elderly (75-82 years) patients undergoing transurethral resection of the prostate. We used 10 ml of 1.5% lidocaine with or without 1:200,000 epinephrine. The plasma epinephrine concentration peaked 5-10 min after the injection in the patients who received epinephrine with anesthetic. There was no significant difference in the plasma epinephrine concentration between the two age groups. Epinephrine caused a significant increase in the heart rate and a significant reduction in the diastolic arterial pressure in both age groups. A significant reduction of the systolic arterial pressure, however, occurred only in the middle-aged patients. Neither the plasma concentration of endogenous epinephrine, heart rate nor arterial pressure changed significantly in the patients who received plain lidocaine. We conclude that the increase in the heart rate and decrease in the diastolic arterial pressure induced by epinephrine when added to an analgesic may not be influenced by advancing age. In contrast, the reduction in the systolic arterial pressure caused by epinephrine may become less pronounced with age.