Anesthesia In Elderly Patients Research Articles

Preprocedural Ultrasonography Versus Landmark-Guided Spinal Anesthesia in Geriatric Patients with Difficult Anatomy: A Prospective Randomized Trial.

This study was aimed to determine whether preprocedural ultrasonography (USG) affects the technical performance of spinal anesthesia in elderly patients with difficulty in palpating landmarks, scoliosis, or previous spine surgery. This prospective study was conducted in 156 elderly patients scheduled for elective orthopedic lower extremity surgery. The patients were randomly divided into 2 groups to receive spinal anesthesia by the preprocedural USG examination (group U) or conventional landmark palpation technique (group P). The primary finding of our study was the rate of successful access to the subarachnoid space on initial needle insertion attempt. Secondary achievements included number of needle insertion attempts, number of needle redirections, total procedure time, needle pain scores, patient satisfaction, and complications of spinal anesthesia. The rate of successful access to the subarachnoid space at the first needle insertion attempt was significantly higher in group U than in group P (74.4% vs 53.8%, p=0.008). Medians (interquartile range) of both needle insertion attempts (group P, 2 [1-3] vs group U, 1 [1-2]; p=0.038) and needle redirections (group P, 3 [2-5] vs group U, 2 [1-4]; p=0.028), requiring to achieve dural puncture, were significantly higher among the patients in group P than those in group U. No statistically significant difference was found between the groups regarding total procedure time, pain scores, patient satisfaction scores, and spinal anesthesia-induced complications (p>0.05). Our study findings showed that preprocedural neuroaxial USG improves technical performance of spinal anesthesia in elderly patients with difficult anatomy.

Response of unilateral spinal anaesthesia in elderly patients admitted to BMC & Allied Teaching Hospital in District BANNU-KPK.

Objectives: The objective of this study was to investigate the possible restriction effects of unilateral spinal anaesthesia on sympathetic block to evade unwanted cardiac effects in elderly patients. Study Design: Cross section study. Setting: Department of Surgery, BMC Allied Teaching Hospitals District Bannu-KPK. Period: June 2018 to January 2020. Material & Methods: In this study, 30 ASA III and ASA IV male adults having an age 55-65 and receiving lower limb surgery were included. The patients were given unilateral spinal anaesthesia (using 0.5% Bupivacaine). All the subjects were maintained in a lateral position having their operated side downwards and were kept in position for a period of 15 minutes. The assessment of the sensory and motor nerves was done, and hemodynamic changes were recorded following spinal anaesthesia. The monitoring was done for half an hour. Results: The observed hemodynamic effects in elderly patients were minimum which demonstrated the effectiveness of unilateral spinal anaesthesia in limiting the sympathetic block, evading the unwanted cardiac effects thus providing high cardiovascular stability. It was observed that the preparation time required for unilateral spinal anaesthesia was a bit longer as compared to conventional method. The technique also proved to be acceptable for patients with an elevated autonomy following surgical procedure and lesser urine retention. Conclusion: When unilateral spinal anaesthesia was administered in admitted patients using lower flow injection method and low volume, stable hemodynamic results were achieved. Patients were more satisfactory. Thus, unilateral spinal anaesthesia is effective in limiting the sympathetic block in old age patients.

Withdrawn: Incidence and Risk Factors of Emergence Delirium after Anesthesia in Elderly Patients at a Postanesthesia Care Unit in Ethiopia: Prospective Observational Study.

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Efficacy of xenon anesthesia in preventing postoperative cognitive dysfunction after cardiac and major non-cardiac surgeries in elderly patients: a topical review.

Elderly patients undergoing major cardiac and non-cardiac surgeries have a high propensity (up to 40–60%) of developing postoperative cognitive dysfunction, which are caused by patient’s factors, type of surgery, intraoperative and postoperative factors. All these pose a challenge to the clinicians. The noble gas xenon does not undergo metabolism or any kind of biotransformation in the body owing to its inert nature. Xenon confers excellent hemodynamic stability and provides excellent recovery at the end of surgery. This topical review discusses advantages of xenon anesthesia in elderly patients undergoing major cardiac and non-cardiac surgeries and whether it is worth using a costly anesthetic in elderly patients for preventing postoperative cognitive dysfunction.

The effects of sedation with propofol and propofol-ketamin combination on postoperative cognitive function in elderly patients undergoing spinal anesthesia

Aim: Elderly patients frequently require surgery. Postoperative cognitive dysfunction (POCD) is an adverse event and reduces thepatient’s quality of life. We aimed to compare the effects of sedation applied with propofol or propofol-ketamine (ketofol) combinationon hemodynamics and POCD during spinal anesthesia in elderly patients undergoing urological surgery.Materials and Methods: Study was performed on 60 ASA I-III patients over 65 years of age. Before the operation (standardizedMini Mental Test) sMMT was applied by a blind researcher. The cases were randomly divided into two groups as propofol (Group P,n=30) and ketofol (Group K, n=30). ECG, SpO 2 , Bispectral Index (BIS), noninvasive blood pressure (NIBP) was monitored. After spinalanesthesia, group P received propofol 0.5 mg/kg IV bolus and then 1.5 mg/kg/hour infusion. Group K received propofol 0.4 mg/kg and ketamine 0.1 mg/kg IV bolus and then propofol 1.2 mg/kg/hour and ketamine 0.3 mg/kg/hour infusion. Hemodynamic andrespiratory data were recorded. The sedation level was monitored by RAMSAY sedation score. sMMT was repeated by the researcherwho performed the initial test at postoperative first 24 hours and postoperative 3rd day.Results: Significant decreases were observed for heart rate, SAP, and MAP in both groups compared with baseline values. Nostatistically significant difference was detected between the groups in sMMT values at postoperative 1 st and 3 rd days. Within-group comparisons revealed significant differences between preoperative sMMT and postoperative 1 st day sMMT and betweenpostoperative 1 st and postoperative 3 rd day sMMT (p< 0.001). No difference was detected between preoperative and postoperative3 rd day sMMT (p< 0.25). In Group P, there was statistically significantly higher injection pain (p<0.05).Conclusion: In this study we found that the recovery period of the patients was longer and BIS values were higher in group K, but nosignificant difference could be found in hemodynamic and cognitive functions.

A study to evaluate the effect of low dose Intrathecal dexmedetomidine as adjuvant to low dose bupivacaine (H) Spinal Anaesthesia in elderly patients undergoing Infraumbilical Surgery

Background: Elderly patients pose a serious challenge to anaesthesia not only because of associated co-morbidities but also due to physiological changes during aging. Therefore lower doses of local anesthetics along with Intrathecal a2-adrenoceptor agonists have been shown to decrease the required doses of local anesthetics and are devoid of major side effects. Hence this study evaluates spinal anaesthesia characteristics in elderly patients. Methods: 120 Patients aged more than 60 years belonging to ASA I,II and III physical status and posted for infraumbilical surgeries were randomized into 2 groups, Group B(Bupivacaine) and Group BD (Bupivacaine + Dexmedetomidine) .Under aseptic conditions lumbar puncture was performed in sitting position at L3-4 / L4-5 interspace and 2.1 ml of study agents were administered. Group B received 10mg of 0.5% hyperbaric Bupivacaine and Group BD received 10mg of 0.5% hyperbaric Bupivacaine and 5mcg of Dexmedetomidine. In all cases monitoring of Blood pressure, ECG, Oxygen saturation and Respiratory rate was done at regular intervals intra-operatively. Sensory block and motor blocks were assessed periodically. Results: There were no clinically and statistically significant changes in heart rate and blood pressure and the mean max fall in HR, SBP, DBP and MAP. However, it was observed that there was a statistically significant (P<0.001) decrease in the time of onset of sensory block and motor block in Group BD(1.68±0.96 and 2.42±1.12) when compared to Group B(2.24±0.81 and 3.33±1.06) . Duration of analgesia and the time for first rescue analgesia was prolonged in Group BD (P<0.001). There were no side effects except for mild sedation in Group BD. Conclusion: Addition of Dexmedetomidine 5 mcg to intrathecal Bupivacaine(H) in elderly patients causes minimum hemodynamic changes, prolongs sensory and motor block.

Pulmonary Artery Pressure and Variations in Arterial Blood Pressure During the Induction Period of General Anesthesia in Elderly Patients.

To determine the correlation of old age, pulmonary artery pressure (PAP) and mean arterial blood pressure (MABP) during anesthetic induction in elderly patients. Prospective cohort study. Central Hospital affiliated to Chongqing Medical University from September 2016 to September 2019. A total of 75 elderly patients with pulmonary hypertension, who underwent surgery under general anesthesia, were inducted. Each 25 patients were allocated into 65-74 years, 75-84 years, and ≥85 years groups. PAP was invasively measured using a right heart floating catheter before induction, while MAP was measured using an invasive radial artery catheter at one minute before and within five minutes after anesthetic induction. PAP and PAMP, both increased with age (p <0.001). MAP at one minute before induction significantly increased with aging, while MAP measured at 1, 3 and 5 minutes after anesthetic induction, exhibited tendencies of significant decrease with aging (p <0.05). The correlation analysis results revealed that mean MAP during anesthesia induction was significantly associated with PASP before induction (r = -0.384 and -0.532 for Kendall and Spearman correlation analyses; both p<0.05). Increased PAP may be involved in the association between with aging and increased risk of hypotension during induction. Key Words: General anesthesia, Hypotension, Pulmonary arterial blood pressure, Old age.

The outcomes of myringoplasty using thinly-sliced cartilage and performed under local anesthesia in elderly patients

The outcomes of myringoplasty using thinly-sliced cartilage and performed under local anesthesia in elderly patients

Anesthesia for arthroscopic surgery on the lower extremities in elderly patients

A significant increase in arthrosis and arthritis causes not only conservative but also other various methods of surgical treatment. Minimal invasiveness, less trauma compared to traditional surgical methods of treatment, the ability to carry out treatment on the principle of one-day surgery determine their greater demand.The paper presents a review of literature data on the features of anesthesia in elderly patients who underwent arthroscopic surgery on the lower extremities.

Comfort and safety of bronchoscopy performed under sedation and local anesthesia in elderly patients.

Although sedation for bronchoscopy improves patient comfort, there is a risk of oversedation in elderly patients. Only a few studies have evaluated the efficacy and safety of sedation for bronchoscopy in elderly patients.This study retrospectively analyzed records of 210 patients who underwent transbronchial brushing and/or biopsy under midazolam sedation at National Hospital Organization Omuta National Hospital between June 2017 and October 2019. Patients were administered 1 mg midazolam following 10 mL 4% lidocaine inhalation. When sedation was insufficient, 0.5 mg midazolam was administered additionally. Diagnostic yield, incidence of complications, amount of oxygen supplementation, decreases in percutaneous oxygen saturation (SpO2), changes in blood pressure, and degree of comfort were analyzed.Patients were divided into the elderly (n = 102) and non-elderly (n = 108) groups. No significant differences were observed in diagnostic yield and procedure time between the 2 groups, and no severe adverse events were noted in the elderly group. The degree of comfort during bronchoscopy was significantly higher in the elderly group. In patients administered < 2 mg midazolam, the amount of oxygen supplementation and decreases in SpO2 were significantly smaller in the elderly group compared to the non-elderly group.The risk of adverse events related to midazolam sedation in bronchoscopy does not increase with age, and sedation improves comfort during flexible bronchoscopy in elderly patients. Moreover, a total dose of midazolam <2 mg is safe for elderly patients undergoing bronchoscopy.

Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

BackgroundCombined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures due to spine degeneration and limitations in positioning. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures.MethodsThis prospective, single-blinded, parallel-group randomized controlled trial included 80 patients (aged ≥65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.ResultsEighty patients completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20 and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5 and 85%, respectively (P < 0.001). The median number of attempts was lower in ultrasound-assisted group (1 [1, 1]) than landmark-guided group (2 [1, 2]), P < 0.001). The median number of needle passes was lower in ultrasound group (1 [1, 2]) than in landmark-guided group (3 [2, 4], P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a high satisfaction score of 4–5 (P = 0.007). Interestingly, subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.ConclusionsModified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.Trial registrationChinese Clinical Trial Register (identifier, ChiCTR1900020819; date of registration, January 20, 2019).

Effect of General Versus Spinal Anesthesia on Postoperative Delirium and Early Cognitive Dysfunction in Elderly Patients.

BackgroundPostoperative cognitive dysfunction (POCD) and delirium are common in the elderly patients, given the controversial results of previous studies about the impact of anesthesia type on the occurrence of these complications.ObjectivesThis study was planned to compare the effects of general and spinal anesthesia on the prevalence of POCD and delirium.MethodsA single-blind non-randomized clinical trial. Setting was in two academic hospitals. Ninety-four patients over 50 years old scheduled for hip fracture fixation. Patients were divided into two groups to receive either general (GA) or spinal (SA) anesthesia. Both Mini-Mental State examination (MMSE) and Wechsler tests were used before the operation and 3 times postoperatively to assess the cognitive function and detect early POCD. The DSM-IV criteria were also used for the diagnosis of delirium. The incidence of delirium and POCD and their precipitating factors were compared between the two groups.ResultsNinety-four patients with a mean age of 67.12 years were studied. The overall prevalence of POCD and delirium was 17.02%; however, it was significantly higher in the GA group rather than the SA group, 29.7%, and 4.25%, respectively (P < 0.001). There was a significant relationship between age (P = 0.048), ASA class (P = 0.034), and educational level with the incidence of POCD, meaning that the probability of developing cognitive impairment decreases with patients’ higher level of education and lower ASA-physical status. Also, the rate of POCD in men was significantly higher than in women (P = 0.026).ConclusionsThe finding of this study showed that, if there is no specific contraindication, neuraxial anesthesia may be preferred over general anesthesia in elderly patients.

THE IMPORTANCE OF NON-INVASIVE REGIONAL BRAIN OXIMETRY IN PREVENTING POSTOPERATIVE COGNITIVE DYSFUNCTION DURING LAPAROSCOPIC CHOLECYSTECTOMY IN ELDERLY AND SENILE PATIENTS

The adverse effect of general anesthesia in elderly patients during surgery requires monitoring of functions and processes to identify their dangerous abnormalities to prevent complications. The aim of the study. To establish the effectiveness of non-invasive regional brain oximetry with rSO2 determination during anesthetic support in laparoscopic cholecystectomy (LCE) to prevent postoperative cognitive dysfunction in elderly and senile patients. Material and methods. 84 elderly and senile patients with diagnosed gallstone disease, acute cholecystitis, who underwent LCE with sevofluran inhalational anesthesia and total intravenous anesthesia with propofol were examined. rSO2 was monitored. Cognitive functions were assessed using neuropsychological scales and the MMSE mental state examination scale. Results. rSO2 was found to be significantly decreased during the carbon dioxide insufflation as compared to before premedication: in LH (left hemisphere) – by 7.0 %, in RH (right hemisphere) – by 6.9 % (Group I); in LH – by 7.4 %, in RH – by 7.5 % (Group II). rSO2 was significantly increased during the surgery, particularly in the middle of the operation, as compared to before premedication: in LH – by 14.66 %, in RH – by 13.94 % (Group I); in LH – by 11.60 %, in RH – by 11.53 % (Group II). The day following the surgery, cognitive functions significantly decreased by 8.7 % on the Luria's test, by 6.0 % on the MMSE test (Group I); in Group II – by 10.1 % and 6.3 %, respectively, as compared to before premedication. On Day 5 after the surgery, cognitive functions decreased by 2.7 % on the Luria's test, by 0.35 % on the MMSE test (Group I); in Group II – by 2.7 % and 0.35 %, respectively, as compared to before premedication. Conclusions. A decrease in rSO2 can occur during LCE in the Trendelenburg position, despite the fact that other intraoperative indicators remain stable, which allows it to remain unrecognized. rSO2 monitoring in the perioperative period contributes to alertness and timely measures to prevent postoperative cognitive dysfunction.

Comparative evaluation of levobupivacaine-fentanyl and ropivacaine - fentanyl in epidural anaesthesia in lower limb orthopaedic surgeries in elderly patients

Epidural blockade with levobupivacaine and ropivacaine, the two new long-acting local anaesthetics, have been preferred in elderly due to low cardiac and central nervous system toxicity.A randomized prospective study was conducted on 100 patients having age 60-85 yr of ASA physical status I, II and III admitted for elective lower limb orthopaedic surgeries under epidural anesthesia. Patients were randomly divided into two groups, Group A received epidural levobupivacaine 0.5% (13ml) and Group B received ropivacaine 0.75% (13ml), both with fentanyl 100 µg (2ml). Time of onset, peak level and time to attain peak level of the sensory block &amp; time of regression upto two segment along with duration of analgesia were noted. Onset time and duration of motor block, hemodynamics and adverse effects were also compared in the two groups. Onset time of sensory block in group A was 5.74±0.66 minutes, while it was 5.68±0.62 minutes in group B.Maximum sensory block was attained in 8.58 ± 0.81 minutes in group A and 8.52 ± 0.84 minutes in group B. 134.2±8.10 minutes were taken for two segment regression in group A, while the time taken in group B was 134±10.88 minutes. Motor blockade mean onset time was 20±3.35 minutes and 20.2±3.64 minutes in group A and group B respectively. The mean duration of motor block in group A was 248.4±13.60 minutes and 247.8±13.29 minutes in group B. The mean duration of analgesia was 382±18.63 minutes in group A, while it was 382.4±15.98 minutes in group B. Results were comparable with regards to sensory and motor blockade parameters, hemodynamics and adverse effects. Both 0.5% levobupivacaine and 0.75% ropivacaine with fentanyl as adjuvant are effective and comparable for epidural anaesthesia in elderly patients with regard to sensory and motor block characteristics along with similar hemodynamic profile.

Application of nerve block in total knee arthroplasty under general anesthesia

To evaluate the effect of femoral and sciatic nerve block in total knee replacement of elderly patients under general anesthesia. From July 2017 to July 2019, 60 patients with unilateral total knee replacement were selected, including 35 males and 25 females; aged 66 to 74(70.2±10.3) years;BMI 18 to 25 (21.3 ± 3.5) kg /m2;course 2 to 3 (1.2±0.3) days. The patients were divided into general anesthesia group (G group) 30 cases and general anesthesia plus nerve block group(GNB group) 30 cases. In GNB group, the femoral nerve sciatic nerve block was guided by ultrasound before anesthesia induction, 20 to 25 ml was injected into the femoral nerve puncture point with 0.5% ropivacaine, 15 to 20 ml was injected into the sciaticnerve puncture point, and the total volume was no more than 40 ml. Postoperative intravenous analgesia (PCIA) was performed in two groups. The dosage of propofol and remifentanil was recorded. Forty-eight hours after operation, the incidence of postoperative nausea and vomiting (PONV) and postoperative farsightedness were recorded. When VAS>3, tramadol 2 mg / kg was injected intravenously, and the additional times of tramadol were recorded. Forty-eight hours after operation, patients' satisfaction score was used to record the length of stay. Compared with group G, the dosage of propofol and remifentanil decreased, the incidence of PONV and the number of additional tramadol decreased, and the patients' satisfaction increased (P<0.05). There was no significant difference in the length of stay between two groups (P>0.05). The ROM and HSS scores of two groups after treatment were higher than those before treatment (P<0.05), and the VAS scores were lower than those before treatment (P<0.05). There was no significantdifference in ROM, VAS scores and HSS scores between two groups before treatment (P>0.05). The ROM and HSS scores of the GNB group after treatment were higher than those of the G group (P<0.05), and the VAS scores were lower than those of the G group (P<0.05). The application of femoral sciatic nerve block in total knee replacement under general anesthesia in elderly patients has good postoperative analgesic effect, and can reduce the dosage of general anesthesia, reduce PONV, and increase patient satisfaction.

English

English

The effectiveness of additional thoracic paravertebral block in improving the anesthetic effects of regional anesthesia for proximal humeral fracture surgery in elderly patients: study protocol for a randomized controlled trial

BackgroundThe innervation of the shoulder-upper-extremity area is complicated and unclear. Regional anesthesia with a brachial plexus and cervical plexus block is probably inadequate for the proximal humeral surgery. Missing blockade of the T1–T2 nerves may be the reason. We conduct this prospective randomized controlled trial (RCT) to explore whether an additional T2 thoracic paravertebral block (TPVB) can improve the success rate of regional anesthesia for elderly patients in proximal humeral fracture surgery.Methods/designThe patients aged 65 years or older, referred for anterior-approach proximal humeral fracture surgery, will be enrolled. Each patient will be randomly assigned 1:1 to receive a combined interscalene brachial plexus with superficial cervical plexus block (IC) (combined interscalene brachial plexus with superficial cervical plexus block) or an IC block combined with thoracic paravertebral block (ICTP) block (combined thoracic paravertebral block with brachial plexus and superficial cervical plexus block). The primary outcome is the success rate of regional anesthesia without rescue analgesic methods. The secondary outcomes are as follows: sensory block at the surgical area, proportion of patients who need rescue anesthesia (intravenously administered remifentanil or conversion to general anesthesia), cumulative doses of intraoperative vasoactive medications and adverse events. The total sample size is estimated to be 80 patients.DiscussionThis RCT aims to confirm whether an additional T2 TPVB can provide better anesthetic effects of regional anesthesia with brachial and cervical plexus block in elderly patients undergoing proximal humeral surgery.Trial registrationClinicalTrials.gov, ID: NCT03919422. Registered on 19 April 2019.

The Effect of Prophylactic Ephedrine on Systemic Hypotension Caused by Induction of Anaesthesia with Propofol and Sufentanil in Elderly Hypertensive Patients: A Prospective Randomized, Double-blind Placebo-controlled Clinical Trial

Objective: To study the effectiveness of prophylactic ephedrine to prevent hypotension caused by induction of anesthesia with propofol and sufentanil in elderly hypertensive patients. Methodology: 70 elderly ASA grade II-III hypertensive patients undergoing elective general anesthesia were randomized into two groups to receive either intravenous ephedrine,100 ug/kg in 5ml normal saline (Group B), or an equal volume of normal saline (Group A) before induction. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR) were recorded at T0 (after entry to the operating room), T1 (1 min after induction), T2 (2 min after induction), T3 ( 3 min after induction), T4 (4 min after induction), T5 (when intubated), T6 (2 min after intubation), and T7 (at the start of the procedure), as well as the incidence of hypotension and bradycardia. Results: SBP, DBP and HR were not significantly different at T0 and were significantly different at T1 to T7 after anesthesia induction. There were statistically significant effect on hypotension and bradycardia between the two groups and group B have a lower risk of hypotension and bradycardia relative to group A. SBP and DBP decreased significantly after induction in both groups. HR decreased significantly in group A while increased in group B. Conclusion: Ephedrine pretreatment can minimize hypotension and bradycardia caused by propofol and sufentanil during the induction of general anesthesia in elderly patients with hypertension.

Study of the rational dose of propofol in elderly patients under bispectral index monitoring during total intravenous anesthesia: A PRISMA-compliant systematic review.

Background:Propofol has been used widely as an anesthetic for elderly patients; however, the drug instructions only indicate that the need for maintenance of general anesthesia in elderly patients is reduced, and not the extent of the reduction. This study has summarized the usage of propofol in total intravenous anesthesia under bispectral index (BIS) monitoring and determined the optimum dosage of propofol for elderly patients.Methods:The study comprised 156 patients undergoing elective surgery under general anesthesia divided into 2 groups according to their age: the elderly group (O group) and nonelderly group (Y group). BIS monitoring was used in both groups during the operation, and propofol and remifentanil were used to maintain anesthesia. The preoperative special conditions, intraoperative maintenance of propofol, remifentanil, fentanyl, cis-atracurium, vasoactive drug use, and hemodynamic changes were summarized.Results:Propofol maintenance in the O group was 3.372 ± 0.774 mg/(kg h), which was significantly lesser than that in Y group (P < 0.05). The incidence of cardiovascular and cerebrovascular diseases and the use rate of vasoactive drugs in the O group were significantly higher than in the Y group (P < 0.05).Conclusion:Propofol maintenance in the O group was significantly lower than that in the nonelderly group; this indicates that the anesthetic drug delivery rate for elderly patients should be reduced.

Effects of prophylactic atropine in prevention of spinal anesthesia induced hypotension and bradycardia in geriatrics undergoing urological surgeries at a resource limited setting in central Ethiopia, 2018; prospective cohort study

BackgroundSpinal anesthesia induced hypotension and bradycardia are common and hazardous in elderly patients. Many techniques are being tried to prevent and treat these problems even if there is a controversy. The effects of prophylactic atropine on prevention of spinal anesthesia induced hypotension and bradycardia in geriatrics for urologic surgeries are not well-established. ObjectiveTo assess the effects of prophylactic atropine in prevention of spinal anesthesia induced hypotension and bradycardia in geriatrics undergoing urological surgeries at a resource limited setting in Central Ethiopia from December 1, 2017 to February 28, 2018 G C. MethodsThis is a prospective cohort study that recruits 76 patients who underwent elective urological surgeries. Independent t-test and Manny Whitney tests were used for numeric data while Chi-Square or Fisher exact test was used for categorical variables. P-values < 0.05 were considered as statistically significant. ResultsThere was no significant difference in baseline heart rate, mean arterial pressure, type & duration of surgery and total fluid administrations. There was a statistically significant difference in mean heart rate and mean arterial pressure at different times of measurement between the exposed and un-exposed groups. Total 1 h vasopressor consumption was minimal in the exposed group (P = 0.038). ConclusionProphylactic atropine with in 1 min of induction of spinal anesthesia in elderly patients undergoing urological surgery might reduce the incidence of hypotension and bradycardia.