Preanesthetic evaluation of the female geriatric patient with hip fracture.

Abstract

Female geriatric patients (mean age 81.0 years; n = 204) with hip fracture (trochanteric n = 86; cervical n= 118) were investigated before anesthesia with regard to social situation, medical condition and routine blood chemistry (including arterial blood gases and acid‐base balance). Forty of these patients were, in addition, subjected to more extensive hemodynamic studies (determination of pressures and resistances in systemic and pulmonary vasculatures and of cardiac function), pulmonary studies (determination of alveolo‐arterial O2 difference and venous admixture) and metabolic studies (determination of oxygen consumption. blood and skeletal muscle levels of glycolytic metabolites and muscle levels of high energy phosphagens). Of the 204 patients, 56% were admitted from their homes and 44% from various types of institutions. The mean interval between the fracture and preanesthetic evaluation was 2.3 days. The medical examination revealed pathological findings in 92% of patients (cardiovascular 78%, mental 39%, pulmonary 14%, endocrinological 12%, neurological 10%). 87% of patients received drug therapy. Anemia (Hb<115 g·1‐1) was more common (24%) than hemoconcentration (Hb<115 g·1‐1, 8%). Low potassium in serum was seen in 14% of the patients. The mean Pao2 level of 9.62 kPa indicated hypoxia in many patients (PaO2<7.5 kPa in 11% of patients) and a mean value of 22% was obtained for pulmonary venous admixture. The systemic vascular resistance was approximately twice as high as in young individuals, but the calculated stroke work index values for both ventricles were low, due to low stroke volume and cardiac output. Metabolic evaluation indicated that these elderly individuals had mainly oxidative Type I muscle fibers, in contrast to that seen in a control group of 11 young females, who had tissue metabolite levels characteristic for glycolytic Type II fibers. The lactate:pyruvate ratio in blood was also much lower in elderly (mean 14.0) than in young (mean 30.6) females. The significance of these findings with regard to anesthetic risk is discussed.