Anesthesia In Elderly Patients Research Articles

Respiratory variation of velocity time integral and peak velocity of left ventricular outflow tract for predicting hypotension after induction of general anesthesia in elderly patients.

Hypotension after induction of general anesthesia may lead to severe complications in elderly patients. This study investigated whether the respiratory variation of velocity time integral (ΔVTI) and peak velocity (ΔVpeak) of left ventricular outflow tract (LVOT) could predict hypotension after induction of general anesthesia in elderly patients. 120 elderly patients undergoing selective operation under general anesthesia were enrolled in this study. ΔVTI and ΔVpeak of LVOT were measured by transthoracic echocardiography before induction of general anesthesia. After induction, mean arterial pressure (MAP) was recorded every 1 minute for 15 min. Hypotension was defined as a decrease of more than 30% in MAP at baseline or MAP below 65 mmHg from the start of induction. Receiver operating characteristic curves with gray zone and multivariate logistic regression analysis were used to assess the ability of ΔVTI and ΔVpeak of LVOT to predict hypotension after induction of general anesthesia. Hypotension occurred in 64 (53.3%) patients after induction of general anesthesia. The area under receiver operating characteristic curves (AUC) for ΔVpeak of LVOT to predict hypotension after induction of general anesthesia was 0.811, and the optimal cutoff value was 13.1% with a gray zone of 9.9% to 13.8%, including 45.0% of patients. The AUC for ΔVTI of LVOT was 0.890, and the optimal cutoff value was 13.8% with a gray zone of 11.1% to 13.9%, including 25.8% of patients. After adjusting for confounders, ΔVTI (Odds ratio = 2.24) and ΔVpeak (Odds ratio = 2.09) of LVOT were two significant independent predictors of hypotension after induction of general anesthesia. ΔVTI of LVOT was a reliable predictor of hypotension after the induction of general anesthesia in elderly patients. ΔVpeak of LVOT should be used cautiously to predict hypotension after induction of general anesthesia due to nearly half of elderly patients in the gray zone.Trial registrationThis study was registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2300077117).

Clinical study on the safety and efficacy of remimazolam in hysteroscopic surgery under general anesthesia in elderly patients

Clinical study on the safety and efficacy of remimazolam in hysteroscopic surgery under general anesthesia in elderly patients

Effect of increased systemic oxygen delivery on postoperative outcomes and quality of life in elderly undergoing major abdominal surgery: A randomised controlled trial.

Studies comparing the intentional increase in oxygen delivery and normal oxygen delivery during general anaesthesia in elderly patients undergoing major abdominal surgery are limited and have reported contradictory findings. Therefore, the study aimed to evaluate the effect of intraoperative increase in systemic oxygen delivery on postoperative outcomes and quality of life in elderly patients undergoing major abdominal surgery. This randomised, blinded, parallel-arm, pragmatic clinical trial included elderly patients of >60 years of age undergoing major abdominal surgery. The patients in the intervention arm received noradrenaline or increased fractional inspiration of oxygen to augment central venous oxygen saturation ⩾75%. The primary outcome measure was composite of in-hospital mortality and major organ complications. The secondary outcome measure included comparison of quality of life. A total of 160 patients were assessed for eligibility, and 146 were randomised in the study groups. The mean arterial and central venous oxygen saturation increased and were significantly higher in the intervention arm. The composite primary outcome occurred in 49.31% in the intervention arm and 57.53% in the usual care arm (relative risk; 95% confidence interval: 0.85; 0.63-1.16; absolute risk reduction; 8.22%; p = 0.32). Furthermore, quality of life at the end of three months was similar (0.658 ± 0.19 versus 0.647 ± 0.19; p = 0.771). In conclusion, central venous oxygen saturation-guided increase in systemic oxygen delivery during the intraoperative period of major abdominal surgery in elderly patients did not reduce predefined composite outcome of in-hospital mortality or organ-specific complications.

Unilateral Spinal Anesthesia Versus Conventional Spinal Anesthesia in Elderly Patient Undergoing Surgery for Upper Extremity of the Femur

Aim of the study: To compare unilateral spinal anesthesia (USA) and conventional spinal anesthesia (SA) in elderly patient undergoing surgery for upper extremity of the femur fracture. Methodology: It was a prospective descriptive analytical randomized study of 16 months including 42 patients carried out in the departments of anestesiology and orthopedics-traumatology of the National Hospital of Niamey. The patients were randomized in two groups: the first group unilateral spinal anesthesia (USA) received a dose of 7.5mg of Bupivacain with 25ɤ of Fentanyl; the second group conventional spinal anesthesia (SA) received 12.5mg of Bupivacain with 25ɤ of Fentanyl. The choice of the administrated dose of Bupivacain were random and alternated half the time. Results: During the time of our study, we registred 42 patients we divided in two groups of 21. In the intraoperative period, the mean arterial pressure (MAP) and the mean heart rate (HR) were comparative in the two groups of patients. There was no difference in the time to installation of the sensory and motor block (7mn and 9mn in USA group vs 7mn and 8mn in conventional SA, P-value=0.79) and neither in it’s duration (153.1mn and 162.8mn in USA group vs 176.5min and 182.81mn in conventional SA group, P-value=0.1 and 0.14). The dose of ephedrine used intraoperative was 14.40mg in conventional SA group and 19.20mg in USA group, the difference were not statistically significant (P-value=0.36). Fluid replacement was done in the two groups with an average of 1.74L in USA group and 1.62L in conventional SA group, with no statistically significant difference (P-value=0.87). The pain was also comparative in the two groups up to 18hours postoperative. The difference in the intensity of this pain was statistically significant between 18hours and 24hours, it was more important in USA group however releived by analgesics of level 1 (P-value=0.002). Intra and postoperative complications were comparative in the two groups ...

Impact of dexmedetomidine-assisted anesthesia in elderly patients undergoing radical resection of colon cancer.

Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy. However, due to the physiological characteristics of elderly patients, the safety of perioperative anesthesia needs special attention. As an α2-adrenergic receptor agonist, dexmedetomidine (Dex) has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure, inhibitory effect on inflammation, and sedative and analgesic effects. Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer. To investigate the anesthetic effects of Dex during radical surgery for colon cancer under general anesthesia in elderly patients. A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital, Qingdao, China were recruited and divided into two groups: A and B. In group A, Dex was administered 30 min before surgery, while group B received an equivalent amount of normal saline. The hemodynamic changes, pulmonary compliance, airway pressure, inflammatory factors, confusion assessment method scores, Ramsay Sedation-Agitation Scale scores, and cellular immune function indicators were compared between the two groups. Group A showed less intraoperative hemodynamic fluctuations, better pulmonary compliance, and lower airway resistance compared with group B. Twelve hours after the surgery, the serum levels of TLR-2, TLR-4, IL-6, and TNF-α in group A were significantly lower than those of group B (P < 0.05). After extubation, the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients, indicating a higher level of sedation. The incidence of delirium was significantly lower in group A than in group B (P < 0.05). The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.

A Comparative Study of Infusion of Ephedrine and Phenylephrine on Hemodynamic Stability After Spinal Anesthesia in Elderly Patients Undergoing Lower Limb Orthopedic Surgeries.

Background Hypotension during spinal anesthesia occurs due to sympathetic nervous system blockade, resulting in decreased systemic vascular resistance and reduced cardiac output. Due to reduced sympathetic tone, peripheral arterial vasodilatation and blood pooling in lower limbs due to venodilatation occur, reducing preload to the heart and stroke volume. The elderly patients have reduced cardiovascular compensatory mechanisms, increasing the frequency and severity of hypotension due to sympathetic blockade after spinal anesthesia significantly. Vasopressors correct hypotension during the intraoperative period to maintain organ perfusion. Fluids can be administered, and if given excessively, can cause fluid overload and urinary retention. This study aimed to compare the effectiveness of vasopressors, phenylephrine, and ephedrine in maintaining hemodynamic stability intraoperatively through prophylactic infusion after spinal anesthesia in elderly patients for lower limb orthopedic surgeries. Methodology A total of 174 elderly patients aged 60 years and above with American Society of Anesthesiologists (ASA) Classification I and II, undergoing lower limb orthopedic surgeries, enrolled in a randomized comparative study, were allocated into three groups: Group P (phenylephrine, n=58) received 250 mcg phenylephrine in 30 ml normal saline using infusion syringe pump, Group E (ephedrine, n=58) received 30 mg ephedrine in 30 ml normal saline using infusion syringe pump, and Group C (control group, n=58) received mephentermine I/V (6 mg bolus) when the fall in blood pressure was below 30% of baseline without any placebo infusion. Hemodynamic parameters (systolic and diastolic blood pressure, mean arterial pressure (MAP), heart rate) at 15, 10, and 5-minute intervals before spinal anesthesia, and at 3, 6, 9, 12, 15, 20, 25, and 30-minute intervals after spinal anesthesia. The need for rescue doses to treat hypotension after spinal anesthesia was recorded. Result At all time intervals following spinal anesthesia, Group E reported heart rate and systolic blood pressure better than Groups P and C, significantly. At 3, 6, 9, 12, 15, and 25-minute intervals following spinal anesthesia, the diastolic blood pressure in Group E was enhanced significantlythan Groups P and C. The MAP in Group E was substantially higher than in other groups at 3, 6, 15, and 20-minute intervals following spinal anesthesia, which was statistically significant. Compared to Groups P and C, Group E required lesser rescue doses to treat intraoperative fall in hypotension 30% below baseline and lesser events of bradycardia. Conclusion Following spinal anesthesia, the preload to the heart is to be maintained with intravenous (crystalloid or colloidal) solutions to maintain cardiac output adequately. Intraoperative use of phenylephrine and ephedrine as a low-dose prophylactic infusion can be used, as it increases both systemic vascular resistance and preload without cardiac stimulation along with intravenous solutions to maintain hemodynamic parameters such as systolic and diastolic blood pressure, MAP, heart rate effectively but preferably ephedrine in elderly patients.

Management of anesthesia in elderly patients, special considerations and challenges

Introduction: Anesthesia management in elderly patients presents distinct challenges due to physiological changes related to aging. Comorbidities, physical frailty and increased risk of postoperative complications are important aspects to be considered. Methods: Systematic reviews of the literature and analyzes of clinical and experimental studies that addressed the management of anesthesia in elderly patients were carried out. Articles published in English, Spanish and Portuguese were selected. The keywords used were "anesthesia in the elderly", "preoperative assessment", "anesthetic techniques", "intraoperative monitoring", "postoperative pain control" and "prevention of complications". Results: Comprehensive and individualized preoperative assessment was identified as crucial for identifying and treating comorbidities and physical frailty in elderly patients. The choice of the appropriate anesthetic technique depends on the type of surgery and the patient's clinical conditions. Careful monitoring during anesthesia, including blood pressure, heart rate, oxygenation and capnography, is essential to detect and intervene early on hemodynamic and respiratory changes. Postoperative pain control in the elderly requires an individualized approach, with appropriate use of analgesics and regional blocks. Complication prevention strategies, such as optimizing hydration, glycemic control, early mobilization and appropriate use of medications, are essential to reduce the risk of delirium, infection and cognitive dysfunction. Conclusion: Anesthesia management in elderly patients requires an individualized and comprehensive approach, taking into account physiological changes related to aging and associated comorbidities. Careful preoperative assessment, appropriate choice of anesthetic technique, strict intraoperative monitoring, postoperative pain control and prevention of complications are essential to ensure a safe perioperative period and successful recovery in the elderly. Keywords: anesthesia in the elderly, preoperative assessment, anesthetic techniques, intraoperative monitoring, postoperative pain control, prevention of complications.

Effects of spinal-epidural anesthesia combined with intravenous etomidate on adrenocortical and immune stress in elderly patients undergoing anorectal surgery: A retrospective analysis.

The management of anesthesia in elderly patients undergoing surgery presents unique challenges, particularly in mitigating stress responses and ensuring stability. Etomidate may alleviate adrenocortical and immune stress. This study aims to investigate the anesthetic effects of combined spinal-epidural anesthesia (CSEA) supplemented with etomidate during anorectal surgery in elderly patients. The medical records of 49 cases treated with CSEA and etomidate (ETO group) and 48 cases treated with CSEA alone (control group) were reviewed and analyzed. All patients received ropivacaine hydrochloride for anesthesia, with the ETO group additionally receiving an infusion of etomidate for sedation. Parameters such as arterial blood gas, visual analog scale (VAS), Ramsay sedation scale (RSS), serum cortisol and norepinephrine levels, pro-inflammatory cytokines, and lymphocyte ratios were assessed at different time points. Compared to the control group, the ETO group showed increased mean arterial pressure, decreased heart rate, and elevated arterial SpO2 30 minutes after anesthesia. The ETO group also had higher RSS scores, lower VAS scores, and reduced serum cortisol and norepinephrine levels. Additionally, decreased levels of pro-inflammatory cytokines, such as interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-8, were observed, along with an increase in the regulatory cytokine IL-10. An increased proportion of CD4+ T cells and a higher CD4/CD8 ratio were also noted. This study demonstrates the benefits of using etomidate to mitigate adrenocortical and immune stress in elderly patients undergoing anorectal surgery.

Effects of Continuous Analgesic Titrated Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Background and Objectives: Anesthetizing elderly patients with hip fractures poses a significant challenge in emergency settings, particularly given the aging population both in Algeria and worldwide. With a high prevalence of comorbidities and polypharmacy, effective anesthetic management becomes paramount. Continuous titrated spinal anesthesia (CTSA) has emerged as a promising technique for addressing these complexities by proposing lower doses of local anesthetic (LA) in this patient population. Methods: This retrospective study involved 40 elderly patients (&gt;65 years) undergoing hip fracture repair. Patients received intermittent dosing of a local anesthetic solution via an intrathecal catheter, utilizing 0.25 ml increments of 0.5% isobaric bupivacaine and 0.25 ml of fentanyl (12.5 μg). Evaluation criteria included hemodynamic stability, incidence of hypotension, extent of sensory and motor blockade, total ephedrine consumption, and patient and surgeon satisfaction. Results: A female predominance was noted, with a mean age of 75 years, and 72% classified as ASA ≥ III. Pertrochanteric fractures accounted for 47% of cases, followed by femoral neck fractures at 53%. Nearly all patients achieved a sensory level ≥ D10, with a failure rate of only 2%. Sedation supplementation was required in 20% of cases, with conversion to general anesthesia in one patient. Complications were minimal, including arterial hypotension (3%), vasoconstrictor use (2%), and bradycardia (0.8%). Overall, both patients and surgeons reported high levels of satisfaction. Conclusions: Our findings demonstrate that CTSA is an effective technique for elderly patients undergoing hip fracture repair, offering the advantages of reduced LA doses, excellent hemodynamic stability, and minimal side effects. Its simplicity and cost-effectiveness further enhance its appeal in clinical practice.

Impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery

BackgroundThis study aimed to investigate the impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery.MethodsA prospective observational study was conducted based on inclusion and exclusion criteria. A total of 384 elderly patients undergoing abdominal surgery under general anesthesia were enrolled in a grade A tertiary hospital in Chengdu, Sichuan Province from October 2021 and October 2022. After anesthesia induction, inflatable warming blankets were routinely used for active heat preservation, and nasopharyngeal temperature was monitored to observe the occurrence of intraoperative hypothermia. Patients were divided into hypothermia group and nonhypothermia group according to whether hypothermia occurred during the operation. Anesthesia recovery time and the incidence of adverse events or unwanted events during anesthesia recovery between the two groups were compared.ResultsThe numbers (percentage) of 384 patients who underwent abdominal surgery developed intraoperative hypothermia occurred in 240 (62.5%) patients, all of whom had mild hypothermia. There were statistically significant differences between mild hypothermia after active warming and nonhypothermia in the occurrence of shivering (χ2 = 5.197, P = 0.023) and anesthesia recovery time (Z = -2.269, P = 0.02) in elderly patients undergoing abdominal surgery during anesthesia recovery, and there were no statistically significant differences in hypoxemia, nausea or vomiting, hypertension, hypokalemia, hypocalcemia, analgesic drug use,postoperative wound infection or postoperative hospitalization days.ConclusionsThe incidence of intraoperative mild hypothermia after active warming was high in elderly patients who underwent abdominal surgery. Mild hypothermia increased the incidence of shivering and prolonged anesthesia recovery time in elderly patients undergoing abdominal surgery.

Comparison of efficacy and safety of equivalent doses of remimazolam versus propofol for gastroscopy anesthesia in elderly patients

Remimazolam, a novel intravenous anesthetic, has been proven to be safe and efficacious in the gastroscopy setting among the elderly. However, reports comparing the effectiveness and safety of using equivalent doses of remimazolam with propofol have not been seen. The aim of this study was to compare the sedation efficacy and safety of the 95% effective doses (ED95) of remimazolam versus propofol combined with sufentanil in the gastroscopy setting among the elderly. In the first step of this two-step study, a modified up-and-down method was used to calculate the ED95 of remimazolam and propofol when combined with 0.1 µg/kg sufentanil in inhibiting body movement of elderly patients undergoing gastroscopy. In the second step, ED95 of both agents calculated in the first step were administered, endpoints of efficacy, safety, and incidence of adverse events were compared. A total of 46 individuals completed the first step. The ED95 of remimazolam was 0.163 mg/kg (95% CI 0.160–0.170 mg/kg), and that of propofol was 1.042 mg/kg (95% CI 1.007–1.112 mg/kg). In the second step, 240 patients completed the trial. The anesthetic effective rates of the remimazolam group and the propofol group were 78% and 83%, respectively, with no statistical difference (P = 0.312). Patients in the remimazolam group had more stable circulatory functions (P < 0.0001) and a lower incidence of pain on injection (3.3% vs. 19.5%, P < 0.0001). The incidence of hypotension was low in the remimazolam versus propofol group (15.6% vs. 39.0%, P < 0.0001). Overall adverse event was low in the remimazolam versus propofol group (21.3% vs. 62.7%, P < 0.0001).In this study, we found that when anesthesia was administered to elderly gastroscopy patients based on 95% effective doses of remimazolam and propofol, remimazolam was as effective as propofol, but was safer with a lower incidence of adverse events.Study registration: Chinese Clinical Trial Registry, ChiCTR2000034234. Registered 29/06/2020, https://www.chictr.org.cn.

A survey study: Anesthesia in elderly patients across Europe.

A survey study: Anesthesia in elderly patients across Europe.

Median Effective Dose of Ciprofol Combined With Sufentanil for Inhibiting the Upper Gastrointestinal Endoscopic Placement Reaction in Elderly Patients.

Ciprofol is a new sedative anesthetic drug that can be used for gastrointestinal endoscopy and induction of general anesthesia, but the appropriate dosage for use in elderly patients has not been determined. Sufentanil is a commonly used opioid in clinical practice, and this study was designed to induce anesthesia in elderly patients using sufentanil in combination with ciprofol. However, the optimal dosage of ciprofol when it is co-administered with sufentanil has not yet been established. This study was designed to find the median effective dose (ED50) and 95% confidence interval (95% CI) of ciprofol for intravenous anesthesia when combined with sufentanil. We studied 57 patients who were scheduled to undergo a diagnostic upper gastrointestinal endoscopy. According to age, it was divided into two groups: 65∼74 years old (group A) and over 75 years old (group B). Using the modified Dixon sequence test method, intravenous bolus of 0.1μg/kg sufentanil was given 3 min before ciprofol is administered, the initial dose of ciprofol was 0.4mg/kg, the upper gastrointestinal endoscopy was placed after reaching the depth of sedation, and vital signs and adverse events were recorded at each perioperative time point (T0-T7). In the group A, when combined with 0.1 μg/kg sufentanil, the ED50 of ciprofol to inhibiting responses to insertion of upper gastrointestinal endoscopy was 0.23mg/kg, and the 95% CI was 0.09∼0.30mg/kg; in the group B, the ED50 was 0.18mg/kg, and the 95% CI was 0.13∼0.22mg/kg. The ED50 of ciprofol in combination with sufentanil (0.1μg/kg) for upper gastrointestinal endoscopy in elderly patients: 0.23mg/kg in group A and 0.18mg/kg in group B.

Comparison of metabolic rates of ropivacaine in cerebrospinal fluid as inferred from plasma concentrations between elderly patients and young patients

BackgroundWith the aging of human society, more and more elderly patients have to undergo surgery and anesthesia. Clinical observations have indicated from time to time that spinal anesthesia in the elderly appears to last longer than in young people, although there is limited research in this area and the mechanism is unclear at present time. This research work is expected to help understand the decline of local anesthetic metabolism in cerebrospinal fluid of elderly patients so as to help them with precise anesthesia and rapid rehabilitation.MethodsTwenty patients with spinal anesthesia in orthopedic lower limb surgery were selected to study the rate of drug metabolism in cerebrospinal fluid in two age groups, i.e.,18–30 years old and 75–90 years old. Ropivacaine in peripheral blood is used as a probe to reflect the speed of drug metabolism in cerebrospinal fluid. The contents of total Aβ protein and hyaluronic acid in the cerebrospinal fluid were investigated as well.ResultsThe equivalent dose of ropivacaine anesthetizes the elderly group for a longer time. The metabolism rate of ropivacaine in an elderly patient was slower than that of a young patient. No significant difference in total Aβ protein between the two groups was observed while hyaluronic acid in the elderly group was significantly higher than that in the young group.ConclusionsThis study shows that the dose of ropivacaine should be reduced when used for anesthesia in elderly patients. The cumulation of ropivacaine and HA appears to imitate the degeneration of central lymphatic circulation metabolism in elderly people.

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

Effect of sitting time on the vasopressor requirement in elderly patients after spinal anesthesia: A randomized controlled study

ABSTRACT Background Neuraxial anesthesia appears to be a highly recommended, well-accepted technique for minimizing perioperative adverse effects in elderly patients. This research was designed to compare the impact of sitting for one, three, and 5 min on ephedrine consumption following spinal anesthesia in the elderly. Methods This randomized, controlled, double-blinded trial was conducted on 66 patients above 65 years undergoing surgeries under spinal anesthesia. Patients were randomly assigned to three equal groups. Patients received spinal anesthesia and then sat before they began to lie down for 1 min in the sitting-1 group, 3 min in the sitting-3 group, and 5 min in the sitting-5 group. Results The most reduction of mean arterial blood pressure (MAP) is in the Sitting-1 group, followed by the Sitting-3 group, and finally, the Sitting-5 group (p < 0.05). The most needed ephedrine was in the sitting-1 group (10 patients), followed by the sitting-3 (6 patients) and then the sitting-5 group (one patient) (p < 0.05). The sensory level was significantly higher in the sitting-1 group, followed by the sitting-3 and then sitting-5 group (p < 0.001). Conclusions Sitting for 5 min after spinal anesthesia in elderly patients decreases the ephedrine requirement and maintains adequate sensory block for surgery.

Retracted: Clinical Observation of General Anesthesia Combined with Spinal Anesthesia in Elderly Patients with Chronic Obstructive Pulmonary Disease.

[This retracts the article DOI: 10.1155/2022/9160145.].

Effect of Intraspinal Anesthesia on Postoperative Recovery in Elderly Patients with Acute Appendicitis: A Retrospective Study.

Acute appendicitis is a common disease in the elderly. Exploring a suitable anesthesia method is crucial in promoting postoperative recovery in elderly patients. Therefore, this study aimed to investigate the clinical effect of intraspinal anesthesia in elderly patients with appendicitis. This study included the clinical data of 217 elderly patients with acute appendicitis who underwent laparoscopic appendectomy (LA) at Tianjin Hospital of Tianjin University from January 2022 to January 2023. After excluding 8 patients who did not meet the inclusion criteria, the data from 209 patients were retrospectively analyzed. Based on the different anesthesia methods, the study participants were divided into a reference group (n = 106) and a study group (n = 103). We compared the heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood oxygen saturation (SaO2), operation duration, hospitalization costs, discharge time, postoperative adverse reactions, inflammatory factor levels, Visual Analogue Scale (VAS) score, recovery time of intestinal peristalsis, anal exsufflation time, out-of-bed time, and incidence of postoperative complications between the two experimental groups. We observed that the study group exhibited higher levels of HR, RR, SBP, DBP, and SaO2 compared to the reference group (p < 0.001). However, there was no difference in operation time between the two groups (p > 0.05). The study group showed lower hospitalization cost and shorter discharge time than the reference group (p < 0.001). Similarly, the study group had lower incidence of postoperative adverse reactions than reference group (p < 0.05). There were no significant differences in the levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α between the two groups before and after surgery (p > 0.05). Furthermore, the study group had a lower VAS score compared to the reference group at 3 h, 6 h and 12 h after surgery (p < 0.001). The recovery time of intestinal peristalsis, anal exsufflation time, and out-of-bed time in the study group were substantially shorter than the reference group (p < 0.001). Additionally, there was no difference in the incidence of postoperative complications between the two groups within 1 year after surgery (p < 0.001). Intraspinal anesthesia, as a safe anesthesia method, can reduce the discharge time of elderly patients with acute appendicitis who underwent LA, and reduce the occurrence of adverse reactions, and is beneficial for postoperative recovery.

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

Retraction: The outcome of thoracic epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery.

[This retracts the article on p. 16 in vol. 6, PMID: 22412771.].