Clinical Survey of Anesthetic Experiences with Geriatric Patients / 대한마취과학회지

ABSTRACT

To evaluate geriatric anesthetic experiences, the clinical record of 970 cases out of total 13,324 anesthetic cases perfomed at Korea university Anam hospital from January 1991 to December 1992 were reviewed according to age, sex, department, operation site, preoperative physical status, preoperative chest X-ray findings, preoperative electmcardiography readings, preoperative pulmonary function test, preoperative concurrent disease, type of anesthesia, duration of operation, intraoperative event, postoperative complication, and mortality. The result were as follows; 1) The number of the cases older than age 65 years was 970 accounting for 7.3% of 13,324 anesthetic cases from the year 1991 to 1992. 2) There were 566 (58.4%) males and 404 (41.6%) females. 3) There were 417 (43.0%) cases between the age of 65 and 69; 323 (33.3%) between the age of 70 and 74; 133 (13.7%) between the age of 75 and 79; 73 (7.6%) between the age of 80 and 84; 15 (1.5%) between the age of 85 and 89; 7 (0.7%) between the age of 90 and 94; 1 (0.1%) between the age of 95 and 100; 1 (0.1%) cases was 103 years of age. 4) In preoperative physical status according to the calssification of American Society of Anesthesiologist, 34 (3.5%) cases were class I, 471 (48.9%) class II, 465 (48.6%) class III, and 10 (1.0%) calss IV. 5) Emergency operation was performed in 107 (11.0%) cases. 6) There were 365 (37.6%) general surgery, 156 (16.1%) orthopedic surgery, 153 (15.8%) genitourinary surgery, 101 (10.4%) otolaryngologic surgery, 66 (6.8%) neurosurgery, 59 (6.1%) chest surgery, 40 (4.1%) gynecologic surgery, and etc. 7) The most frequent operation site was upper abdominal region in 242 cases (24.9%) and lower abdominal region in 184 (19,0%), upper and lower extremities in 165 (17.0%), head and neck in 126 (12.9%) and so on. 8) The findings of preoperative chest X-ray revealed that 502 (51.7%) cases were within normal limits. The most frequent abnormal finding was hypertensive heart changes in 128 (13.2 %). Another findings were arteriosclerotic changes in 72 (7.4%), inactive pulmonary tuberculosis in 37 (3.8%), emphysematous changes in 34 (3.5%), bronchiectasis in 19 (2.0%) and so on. 9) The preoperative electrocardiographic findings revealed that 452 (46.6%) cases were within normal limits. The abnormal findings were as follows ; left ventricular hypertrophy in 113 (11.6%), sinus bradycardia in 67 (6.9%), myocardial infarction in 45 (4.6%), myocardial ischemia in 32 (3.3%), and so on. 10) Preoperative pulmonary function test was performed in 702 (72.6%) cases. Two hundred sixity five cases (37.5%) showed abnormal results consisting of obstructive type in 34.7%, restrictive type in 24.9%, mixed type in 21.5%, and small air way disease in 18.9%. 11) Three hundred sixty one (37.3%) of the total cases had preoperative concurrent illness consisting of hypertension in 158 (16.3%), chronic obstructive pulmonary diseases in 66 (6.8%), myocardial infarction in 37 (3.8%), myocardial ischemia in 34 (3.5%), diabetes mellitus in 32 (3.3%), and so on. 12) The type of anesthesia used in these case were 678 (69.9%) general anesthesia, 96 (9.9%) spinal anesthesia, 84 (8.7%) combined anesthesia, 82 (8.4%) epidural anesthesia, and 30 (3.1%) brachial plexus block. 13) The duration of operation was 1~2 hours in 329 (33,9%) cases, 2~3 hours in 267 (27.5%), 3~4 hours in 126 (13.0%), and so on. 14) The most frequent intraoperative envent was hypertension in 155 (16.0%) cases. And hypotension in 72 (7.4%), premature ventricular contraction in 12 (1.2%), ohguria in 9 (0.9%), bradycardia in 8 (0.8%), myocardial ischemia in 8 (0.8%), myocardial ischemia in 7 (0.7%), and hyperglycemia in 7 (0.7%) were noted, 15) One hundred six cases (10.9%) were sent to intensive care unit for postoperative care. 16) The most frequent postoperative complication was hypertension in 154 (15.9%) cases. Hypotension in 21 (2.2%), myocardial ischemia in 13 (1.3%) and etc, were noted. 17) Overall mortality rate was 1.2%. The mortality rate was 0.2% in elective cases, and 9.3% in emergency ones.