ABSTRACT
Due to improvements in medical care, the socioeconomic level and public health, life expectancy has dramatically increased. Thus, advances in the development of life-support systems and the control of infection have resulted in many surgical and anesthetic procedures being performed on extremely elderly patients. In contrast to younger patients, elderly patients may manifest more than one pathologic process associated with progressive degenerative changes in various organs of the aged, especially in the heart, brain, and kidney. Since both progressive degenerative change occurring in the elderly population and the cumulative incidence of disease in that population result in death intraoperatively or during the immediate postoperative period, the anesthesiologist must be particularly alert to the possibility of anesthetic risks in the elderly. The elderly patient is more likely to have hypertension, congestive heart failure, cardiac dysrhythmias, chronic pulmonary disease, and diabetes. Preoperative evaluation and treatment of those conditions must be extensively reviewed prior to the induction of anesthesia. To evaluate geriatric anesthetic experiences, 539 cases of patients aged over 60 years of 4,266 anesthetic cases admitted to P.M.C. from January to December, 1986 were analyzed according to age, sex, physical status, anesthetic technique an6 agents, surgical department, preoperative chest X-ray findings, preoperative E.C.G findings, and postoperative complications. The results are as follows. 1) Of 4,266 anesthetic patients 539(12.6%) were over 60 3ears of age and 322(59.7%) were males and 217(40.3%) females. 2) In the classification of physical status, the most common evidence was class 2 in 303 cases. Emergency surgery comprised 27.1%. 3) The anesthesia technique employed was usually general anesthesia and this suggested that balanced anesthesia used with narcotics offers several advantages to geriatric patients. 4) In the surgical department, 310 cases(57.5%) were for general surgery, 75 cases(13,9%), orthopedic surgery; 57 cases(10.6%), urology; and 49 cases(9.1%), neurosurgery, respectively. Cancer was present in 198 cases(36.7%), 5) Preoperative chest X-ray findings: The most common finding was pulmonary tuberculosis in 44 cases(8.2%). Pneumonia, pulmonary emphysema, and so forth were also observed. 6) Preoperative E.C.G findings: The most common findings was myocardial ischemia in 48 cases(8.9%). Also myocardial infarction observed in 8 cases(1.5%) 7) Postoperative complications were as follows: The most common incidence was wourid infection in 29 cases(5.4%) followed by pneumonia. There were a number of miscellaneous complications. but postoperatively, they did not present any significant problems. 8) The overall mortality rate was 3.5%(19 cases). The difference in the mortality rate related to age was not statistically significant(p>0.1), but the mortality rate related to physical status was statistically significant(p<0.001). 9) Optimizing a patient's preoperative condition by the anesthesiologist, consultants, and other physicians was assumed to reduce perioperative morbidity and mortality.