Comportamiento de la dosis intradural de fentanil en el paciente geriátrico: Its behavior in elderly patients / Intradural doses of Phentanyl

Introducción: El fentanilo es uno de los fármacos más usados para producir analgesia tras su administración intratecal, especialmente asociado a anestésicos locales. La disminución del dolor postoperatorio es la piedra angular de una evolución adecuada pues se ha observado que este solo hecho reduce problemas en diferentes órganos y sistemas, especialmente en el paciente anciano. Objetivos: Determinar el comportamiento de la dosis intradural de fentanilo asociado a bupivacaina en el paciente anciano. Material y Método: Se realizó un estudio observacional, prospectivo, de casos control, en 100 pacientes. Se conformaron cuatro grupos con 25 pacientes en cada uno, procediéndose de la siguiente manera: Grupo A: no se empleo fentanil. Grupo B: 12.5 µg de fentanil. Grupo C: 25 µg de fentanil. Grupo D: 50 µg de fentanil. En todos los grupos se empleó bupivacaina al 0.5% 7.5 miligramos como anestésico local. Las variables utilizadas fueron; edad, sexo, tipo de cirugía, efectos adversos o complicaciones intraoperatorias y analgesia postoperatoria. Resultados: Fue frecuente el grupo de edades entre 60 y 70 años. No existió diferencia significativa en cuanto al sexo, la cirugía ortopédica de miembros inferiores y la urológica fueron frecuentes en igual número, los efectos adversos y complicaciones se observaron en la medida en que se fue incrementando la dosis de fentanil, el prurito, la somnolencia y la bradicardia fueron los que mas incidieron, no se presento en ninguno de los pacientes depresión respiratoria, vómitos, ni retención urinaria. Conclusiones: La calidad de la analgesia se incremento en la medida en que se aumento la dosis de Fentanil.

Introduction: Phentanyl if one of the more used drugs to produce analgesia after its intrathecal administration, especially in association with local anesthetics. Decrease of postoperative pain is the rule of a proper evolution since it is observed that this only fact reduce problems in different organs and systems, especially in elderly patient. Objectives: To determine behavior of intradural dose of Phentanyl associated to Bupivacaine in these patients. Material and Methods: We performed a prospective observational study of index cases in 100 patients. Four groups were created including 25 patients each, proceeding as follow: Group A: no-Phentanyl. Group B: 12.5 ?g of Phentanyl. Group C: 25 ?g of Phentanyl. Group D: 50 ?g of Phentanyl. In all groups we used Bupivacaine (0.5%-7.5 mg) as local anesthetic. Variable used were: age, sex, surgery, side effects or intraoperative complications and postoperative analgesia. Results: The more frequent age group was between 60 and 70 years. There wasn't a significant difference regards sex; orthopedic surgery of lower limbs, and the urologic one were the more frequent in a similar number, side effects and complications were seen according to an increase in Phentanyl dose; pruritus, drowsiness and bradycardia had the greatest incidence. There wasn't respiratory depression, vomiting and urinary retention. Conclusions:Analgesia quality was increased according to a rise of Phentanyl dose.

El paciente geriátrico y el acto anestésico: nova et vetera / The geriatric patient and the anesthetic act: nova et vetera

A medida que la población envejece, más pacientes geriátricos deben someterse a cirugías, bien sea electivas o urgentes. Dado que el envejecimiento es una experiencia única y personal, cada paciente que va ser sometido a cirugía debe abordarse de manera individual. La valoración de la reserva funcional ha llegado a ser la piedra angular en el plan anestésico y es marcador pronóstico integral. Se dan pautas para su valoración, así como de la capacidad funcional, con el fin de minimizar los riesgos de la anestesia y la cirugía. En la presente revisión se discuten los cambios de los órganos con la edad, el papel de las enfermedades intercurrentes como factores determinantes del riesgo, otros factores que incrementan el riesgo de complicaciones y los problemas perioperatorios que se pueden presentar, entre otros, los relacionados con el estado cognitivo.

As the population ages, more geriatric patients should undergo Esther elective or urgent surgery. Given that ageing is a unique and individual experience, each patient that goes to surgery, must be addressed on an individual basis. The assessment of the functional reserve has become the cornerstone in the anesthetic plan and is the fore-casting integral marker. Guidelines for its assessment are given, as well as its functional capacity, in order to minimize the risks of anesthesia and surgery. In this review, changes in organs with age, the role of intercurrent diseases, and other factors that increase the risk of complications, perioperative problems that may arise, including those related to cognitive stes are discussed.

Anesthesia for Orthopedic Surgery in Patients Older than 80 Years / 대한마취과학회지

BACKGROUND: The number of elderly patients undergoing orthopedic surgery is steadily growing. Aging modifies the physiology, pharmacokinetics and pharmacodynamics, and co-morbidity is common in the elderly. Therefore, it is important and necessary to evaluate the anesthetic management for orthopedic surgery in elderly patients. METHODS: Four hundred and twenty two patients, older than 80 yr, who underwent orthopedic surgery, between September 1996 and March 2004, were retrospectively reviewed according to age, sex, operation site, preexisting concomitant disease, anesthetic techniques, postoperative complications and mortality. RESULTS: Three hundred and fifty seven patients had a pre-existing concomitant disease. There were no meaningful differences in the postoperative morbidity and mortality according to the anesthetic technique employed, although there was a clearly reduced incidence of deep vein thrombosis with regional anesthesia. There were significantly higher postoperative morbidity and mortality among patients with a pre-existing concomitant disease. CONCLUSIONS: Appropriate anesthetic management is suggested for patients older than 80 yr undergoing orthopedic surgery, which will require proper preoperative evaluation, sufficient vigilance of their hemodynamics and an awareness of impaired circulatory function, as well as other age related concerns.

Comparisons between Etomidate and Thiopental Sodium as an Induction Agent of General Anesthesia in Elderly Patients / 대한마취과학회지

BACKGROUND: This study was designed to determine whether etomidate-based induction can provide better hemodynamics than a standard thiopental sodium-based anesthetic induction in elderly patients. METHODS: Sixty ASA physical status 1 or 2 elderly patients scheduled for elective surgery were randomly allocated into one of three groups (Group 1; thiopental sodium, Group 2; etomidate, Group 3; pre-treatment with 0.02 mg/kg of midazolam and etomidate). We measured and compared hemodynamic changes (mean arterial pressure, heart rate), the doses of thiopental sodium and etomidate for loss of consciousness, the incidence and grade of myoclonus, and the bispectral index during induction of anesthesia. RESULTS: There were no significant differences in mean arterial pressure and heart rate among the three groups. Myoclonus occurred in 45% of patients receiving etomidate, 40% of patients receiving midazolam pre-treatment and etomidate. Pre-treatment of midazolam reduced the dose of etomidate for loss of consciousness by 20% in Group 3. The values of BIS decreased significantly from 1 minute after infusion of thiopental and etomidate, and reached 56.9 +/- 12.3 in group 1, 41.8 +/- 9.1 in group 2, and 45.8 +/- 8.5 in group 3 just before endotracheal intubation. CONCLUSIONS: These results indicate that there is no significant difference between etomidate and thiopental sodium as anesthetic induction agents in elderly patients. Pre-treatment with a small dose of midazolam reduced the dose of etomidate for loss of consciousness, but did not affect the incidence of myoclonus and hemodynamic changes during induction of anesthesia with etomidate.

Clinical Survey of Geriatric Anesthesia / 대한마취과학회지

Nowdays the number of geriatric patients has increased gradually and the risk for anesthesia and surgery is poor compared with younger patients because of chronic systemic diseases and aging of physiologic function. We analyzed 982 cases of geriatric anesthesia patients aged over 65 years performed at Presbyterian Medical Center from January 1992 to December 1993. The patients were evaluated according to age, sex, preoperative physical status, preoperative laborative findings, concurrent illness, anesthetic consult, department, operation site, anesthesia type, duration of anesthesia, intraoperative events, postoperative complications and mortality. The results were as follows; 1) The number of the cases older than 65 years was 982 cases(8.4%) out of total 11,629 cases. There were 548 cases(55.8%) of male and 434 cases(44.2%) of female. 2) By the classification of physical status of American Society of Anesthesiologist, the most common evidence was class 2 in 587 cases(59.8%) and emergency operation was performed in 237 cases(24.1%). 3) 520 cases(53.0%) had concurrent illness and hypertension was most common in 129 cases(24.8%). 4) Preoperative anesthetic consult was performed in 421 cases(42.9%) and the frequent consult problem was cardiovascular in 155 cases(36.8%). 5) The most common department and operation site was general surgery in 461 cases(47.0%), lower abdominal region in 265 cases(27.0%) respectively. 6) The anesthetic technique employed was usually general anesthesia; 710 cases(72.3%). 7) The intraoperative events and postoperative complications were revealed in 244 cases(24.8%), 225 cases (22.9%) respectively and hypertension was leading problem. 8) Overall mortality rate was 1.9%(19 cases). The mortality rate was 0.7% in elective cases and 5.9% in emergency cases. In conclusion, anesthesiologists should attention to perioperative management of geriatric patients to decrease the morbidity and mortality.

A Clinical Study of Geriatric Anesthesia / 대한마취과학회지

It is widely believed that, compared with younger patients, elderly having surgery have a significantly high incidence of complications or death. So, we reviewed clinical records of 2094 patients aged over 65 out of 41,129 surgical cases performed at Catholic University Kang-Nam St. Mary Hospital from May 1980 to December 1989. The case were analysed statistically according to age, sex, department, preoperative physical status, operation site, anesthetic techniques and agents, duration of anesthesia, intraoperative transfusion, intraoperative complication, asaociated disease, postoperative complication and mor- tality. The results were as follows: 1) Of the total 41, 129 cases, 2,094 cases (5.1%) were over 65 years of age consisting of 1,039 male (49.6%) and 1,055 female (50.4%). 2) The most common age group for geriatric anesthesia (1, 164 cases) was 65~70 years of age (55.6%). 3) The rate of elective and emergency surgery was 90.2% (1,889 cases) and 9.8% (205 caaes). 4) Among the 2,094 cases, 1.029 cases were general surgry (49.1%), 373 cases were orthopedic surgery (20.7%) 5) The number of upper abdominal surgery cases were 643 cases (30.7%) and the number of lower abdominal surgery cases 433 cases (20. 7%). 6) The duration of anesthesia was within 1 hour in 286 case (13.1%), 1~2 hours in 755 cases (36.1%), 2~3 hours in 516 cases (24.6%). 7) The technique of anesthesia was done under the general anesthesia for 1,445 cases (69.0%) and epidural anesthesia for 433 cases (20.7%). 8) The anesthetics were halothane for 631 cases (30.1%), enflurane for 435 cases (20.8%) and fentanyl for 364 eases (17.8%), lidocaine and bupivacaine mixture for 254 cases (12.1%). 9) Among the 2.094 cases, 1,471 cases had preoperative disease (70.3%), which of the most common disease (24.1%) was the chronic obstructive pulmonary disease (545 cases). 10) The numbers of postoperative death were 40 cases (1.9%).