Background: It might be difficult to treat hypotension after spinal or epidural anesthesia in older adults. There is a danger of volume overload or cardiac compromise when PSA hypotension is treated with fluids (colloids or crystalloids) or vasoconstrictors. When decreased peripheral vascular resistance is present, dexamethasone is utilized as a treatment. Methods: Eighty patients, aged 60 years or more were recruited to receive a single preoperative intrathecal dose of dexamethasone 8 mg (dexamethasone group) (40 patients), and 40 patients were given placebo receiving normal saline (Control group) in a randomized, double-blind trial. Variations in blood pressure and heart rate in addition to the needs of ephedrine and/or atropine following spinal anesthesia (SA) were recorded.  Result: The mean age of patients in 4dexamethasone group was 67.8±6.8 years and most of them were females (72.5%). The mean arterial blood pressure showed no significant difference between the studied groups regarding their baseline and all measures of mean arterial blood pressure. However, at all measures the MAP was higher in the dexamethasone group than the control group. Conclusion: Post-spinal anesthesia hypotension in elderly patients was less common after receiving a single preoperative intrathecal dose of dexamethasone 8 mg than control.