Analgesia for spinal anesthesia positioning in elderly patients with proximal femoral fractures: Dexmedetomidine-ketamine versus dexmedetomidine-fentanyl Elderly patients with femoral fractures are anticipated to endure the most pain caused by positional changes required for spinal anesthesia Delirium can occur in up to 80% of elderly postoperative patients depending upon the type and extent of surgery, perioperative anesthesia and analgesic needs of the patient, and type of pain therapy administered. It is more common with emergency, trauma, and major surgery Introduction. Spinal anaesthesia (SA) is the most commonly used anesthetic technique for transurethral resection of prostate (TURP) surgery in geriatric patient population.Many geriatric patients have coexisting cardiac or pulmonary diseases, so it's very important to limit the distribution of the block to prevent the possible hemodynamic and pulmonary adverse effects Introduction: Hypotension is the most complication during spinal anesthesia. Efforts to prevent hypotension have been attempted like preloading with crystalloids, colloids or use of vasopressors. The role of volume preloading to prevent hemodynamic changes associated with spinal anesthesia in elderly patients has been recently questioned Spinal anesthesia is a commonly used technique for lower limb surgery in the elderly. Since the elderly population is increasing, and since these patients often have concomitant medical problems and reduced physiologic adaptation capacities, spinal anesthesia can be an ideal anesthetic technique [3,4,14]
We assessed the risks and benefits of the administration of fentanyl during spinal anesthesia in the elderly. Forty patients (70-83 yr) undergoing knee or hip replacement were studied. Preoperatively, cognitive function (minimental state examination [MMSE]), associated pathology, medications, and treatment were evaluated Elderly patients with femoral fractures are anticipated to endure the most pain caused by positional changes required for spinal anesthesia.To improve pain relief, we compared the analgesic effects of intravenous dexmedetomidine-ketamine and dexmedetomidine-fentanyl combinations to facilitate patient positioning for spinal anesthesia in elderly patients with proximal femoral fractures Traditionally, spinal anaesthesia is advocated as it allows continuous monitoring of the patients mental function as a warning sign for development of TUR syndrome. Treatment can be difficult and hypertonic saline, whilst effective, may cause further neurological damage. There is little to choose between regional and general anaesthesia for TURP
Spinal anesthesia blocks small, unmyelinated sympathetic fibers first, after which it blocks myelinated (sensory and motor) fibers. The sympathetic block can exceed motor/sensory by two dermatomes. Spinal anesthesia has little effect on ventilation but high spinals can affect abdominal/intercostal muscles and the ability to cough Elderly patients undergoing spinal anesthesia, however, may be especially at risk of hypothermia because low core temperatures may not trigger protective autonomic responses Patients were randomly distributed in two groups who received spinal anesthesia in a final volume of 3.5 mL: 12.5 mg of hyperbaric bupivacaine plus saline (Group SS, n = 21) or the same dose of the local anesthetic plus 25 micro gram of fentanyl (Group FN, n = 19) Sixty patients undergoing elective hip surgery under spinal anesthesia in the geriatric age group with albumin levels below 3 g/dl were randomly divided into Group I and Group II. After administration of spinal block, Group I were given 0.05 mg/kg bolus midazolam, and then 0.02-0.1 mg/kg/hr dose infusion was begun Abstract. We determined the incidence of persistent back pain (PBP) after non‐obstetrical spinal anaesthesia (SPA) and investigated factors predisposing to such pain in a prospective 1 yr follow‐up study in 245 patients undergoing elective general or trauma surgery (218 patients undergoing single SPA, 27 undergoing two to six SPAs)
Postoperative daily living activities of geriatric patients administered general or spinal anesthesia for hip fracture surgery: A retrospective cohort study. Fukuda T(1)(2), Imai S(3), Nakadera M(3), Wagatsuma Y(1)(4), Horiguchi H(3). Author information: (1)1 University of Tsukuba, Tsukuba, Ibaraki, Japan Basics of Anesthesia, 5th ed. Elsevier (China) p. 525, 2007]. Epidural anesthesia should be strongly considered in elderly patients, as they offer improved function (ie decreased atelectasis, shorter time to extubation, and less ICU time according to a randomized trial of 915 abdominal surgery patients [Rigg JR et al. Lancet 359: 1276, 2002] Methods: Forty patients aged 70 or more were randomly allocated to receive either general anesthesia (sevoflurane, nitrous oxide in oxygen, G group, n = 21) or spinal anesthesia (0.5% bupivacaine, S group, n = 19). G group received the oxygen therapy during the 12-hour postoperative period Spinal or general anaesthesia for surgery of the fractured hip? BrJ Anaesth 1986; 58: 284-91. PubMed Article CAS Google Scholar 32. Davis FM, Laurenson VG. Spinal anaesthesia or general anaesthesia for emergency hip surgery in elderly patients. Anaesth Intensive Care 1981; 9: 352-8
Incidence. The reported incidence of postoperative delirium varies widely. Incidence in patients in the general surgery group for all age groups ranges from 5% to 10% and, for the elderly, from 10% to 15% ; for those in the orthopedic surgery group, from 28% to 61.3% ; and for those in the cataract surgery group, from 1% to 3% .Knill et al. found a 12% incidence of idiopathic postoperative. Spinal anaesthesia is performed for lower abdominal and lower limb surgeries as it reduces post operative morbidity and other complications. Usually spinal anesthesia is performed using the midline approach. This can be difficult in elderly patients with cal-cified ligaments. It can also be difficult in obese patients
Eight patients in group C and two patients in group U required ephedrine (P = 0.038). Conclusions: The DSCSA is a highly effective parameter for spinal anesthesia in geriatric patients undergoing TURP, a modified dose of local anesthetic is a critical factor for controlling the sensory level Lessire H, Pfisterer M, Schweppe-Hartenauer ML, Puchstein C. hypotensive epidural anaesthesia and spinal anaesthesia on blood Hemodynamic effects of a combination of general and peridu- loss and coagulation during and after total hip arthroplasty. Acta ral anesthesia during anesthesia induction in geriatric patients Background and objectives: The use of sedatives during regional anesthesia can lead to life-threatening hypoxemia. Older patients particularly are prone to enhanced effects of these drugs. We studies whether oral premedication with benzodiazepines produced hypoxemia during spinal anesthesia in elderly patients Spinal anaesthesia is generally believed to be protective or neutral for respiratory complications 14, 15 but this in turn may lead to greater use of spinal anaesthesia in patients at risk of respiratory complications 24. The proportion of patients with COPD who received spinal anaesthesia was almost double that of those who had a general.
Ultrasound-assisted Versus Conventional Landmark-guided Paramedian Spinal Anesthesia in Elderly Patients. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government 1.5h and the patients are woken at the end. Following a course of speech therapy, onlyone patient has felt it neces-sary to have a repeat procedure to have a larger prosthesis inserted. This repeat procedure was completed in less than Anaesthesia, 1999, 54, pages 492-514 Correspondenc Their audit revealed just two postdural puncture headaches (PDPHs) in 275 elderly (> 60 years) patients after spinal anaesthesia, the majority performed with Quincke needles. I performed a survey of 120 patients some years ago. At the time, all nonobstetric spinal anaesthesia was performed with Quincke needles of 22, 25 or 26 gauge Neuraxial anesthesia is recommended as a well-accepted option to minimize the perioperative side effects in the geriatric patients. The available data from the current researches have shifted the focus from the conventional approach to spinal anesthesia to the concept of low dose local anesthetic combined with opioids. What remains clear from all these studies is that hemodynamic stability is.
. Funder, Jacob Steinmetz and Lars S. Rasmussen Introduction Because of the population ageing, an increasing number of elderly patients are attending healthcare services, and this quantity is likely to grow in the future . A risk o The Effect of General and Spinal Anesthesia on Balance Control in Elderly Patients Alejo Suárez and Omar Macadar Faculty of Medicine, Universidad de la República and Instituto de Investigaciones Biológicas Clemente Estable, Montevideo, Uruguay Abstract: Falls are a major problem in the elderly population, but few communications ad-dress the. Patients in the spinal anesthesia group had a significantly higher percentage of total dependence for toileting than did patients in the general anesthesia group (spinal vs. general: 40.3% vs. 36.7%; p < 0.003). A total of 174 patients died and were excluded from the analysis: 109 (1.6%) in the general anesthesia group and 65 (1.2%) in the. Bordes J, Gaillard PE, Lacroix G, Palmier B: Spinal anaesthesia guided by computed tomography scan in a patient with severe post-polio sequelae. Br J Anaesth 2010;105:702-703. Higashizawa T, Sugiura J, Takasugi Y: [Spinal anesthesia in a patient with hemiparesis after poliomyelitis]. Masui 2003;52:1335-1337 The majority of these papers were observed in obstetric patients. Comparing single shot spinal anesthesia, combined spinal-epidural blocks and continuous spinal anesthesia in orthopedic surgery of elderly patients no significant difference was observed among population 17. 5.6 The use of the introduce
Increased life expectancy, safer anesthesia, and less invasive surgical procedures have made it possible for a greater number of geriatric patients to be considered for surgery Post-spinal anesthesia (PSA) hypotension in elderly patients is challenging. Correction of PSA hypotension by fluids either colloids or crystalloids or by vasoconstrictors pose the risk of volume overload or compromising cardiac conditions. Dexamethasone is used to treat conditions manifested by decrease of peripheral vascular resistance. The research team was the first to test the hypothesis. Hip fracture is a common and critical event for elderly patients ().Both general and regional anesthesia are associated with side effects in geriatric patients ().Although regional anesthesia might have benefits over general anesthesia (), hemodynamic stability may be impaired and can lead to myocardial ischemia ().Hypotension is more common, and also more hazardous, in elderly patients, as. Patients may be agitated, withdrawn or have a combination of both. Delirium may present immediately after waking up from anesthesia or one to three days after. One study showed that it occurred in 13.2 percent of elderly patients following general surgical procedures but can vary depending on several factors
Olofsson C et al: Low-dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients. Acta Anaesthesiol Scand 2004;48:1240-1244. Ben-David B et al: Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology 2000;92: 6-10 Spinal anesthesia using the midline approach might be technically difficult in geriatric population. We hypothesized that pre-procedural ultrasound (US)-guided paramedian technique and pre-procedural US-guided midline technique would result in a different spinal anesthesia success rate at first attempt when compared with the conventional landmark-guided midline technique in elderly patients Therefore, we performed a prospective, randomized, open-label study designed to compare the effects of general vs spinal anesthesia on frontal rS o 2 in geriatric patients undergoing emergency surgical fixation of the neck of femur. 2. Materials and method Patients undergoing an operation under spinal block expect reliable surgical anesthesia, and an inadequate block will generate anxiety for both patient and clinician. In addition, by conducting this invasive procedure, such as spinal anesthesia, we subject patients to small but well-established risks Although young patients have the highest risk of C-spine injury at C4-7 (the most mobile portion of the C-spine), geriatric patients have increased spinal rigidity and are more likely to suffer from injuries to odontoid and C2. Therefore, C-spine imaging often is warranted in geriatric patients with blunt trauma that may have affected the C-spine
Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up. Am J Orthop 2000 ; 29 : 25 - 35 . OpenUrl CrossRef PubMe Materials and Methods: A prospective, randomized, and double-blind study was conducted on 110 elderly patients, aged 50-70 years, of the American Society of Anesthesiologists Grade I or II category, scheduled for various surgeries under spinal anesthesia. The patients were randomly divided into two groups of 55 each to receive either. Cite this: Effects of Bupivacaine or Levobupivacaine on Cerebral Oxygenation During Spinal Anesthesia in Elderly Patients Undergoing Orthopedic Surgery for Hip Fracture - Medscape - Jan 31, 2019. In clinical studies, elderly patients exhibited a greater spread and higher maximal level of analgesia than younger patients. Elderly patients also reached the maximal level of analgesia more rapidly than younger patients, and exhibited a faster onset of motor blockade. Spinal anesthesia has also been reported to prolong the second stage of.
In geriatric patients scheduled for hip or knee surgery, neuraxial anesthesia is a safe and effective anesthesia method and may be a better option than general anesthesia. Unfortunately, establishing neuraxial anesthesia is not always easy in this group of patients. Anatomical abnormalities, such as spinal stenosis, scoliosis, and narrowed interspaces, contribute to the difficulties that. Pre-procedural Ultrasound Techniques Versus Conventional Landmark Technique of Spinal Anesthesia in Elderly Patients. The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government
Abstract: Spinal anesthesia-induced hypotension (SAIH) occurs frequently, particularly in the elderly and in patients undergoing caesarean section. SAIH is caused by arterial and venous vasodilatation resulting from the sympathetic block along with a paradoxical activation of cardioinhibitory receptors. Bradycardia after spinal anesthesia (SA. Conclusions . This prospective, randomized, clinical trial in very elderly patients could not show differences in cerebral oxygenation between B and LB during spinal anesthesia, but lower sensory. Conclusions: In elderly patients undergoing hemiarthroplasty of the hip, induction and maintenance with sevoflurane provide a rapid emergence from anaesthesia without more depression of postoperative cognitive function compared with unilateral spinal anaesthesia. This technique represents an attractive option when patient refusal, lack of.
This time was chosen because of a previous study that reported mean time to ambulation after mepivacaine spinal anesthesia at 212 min. 8 Physical therapists, who were blinded to group assignments, were informed of the time of spinal placement by an investigator and then assessed patients for ambulation between 3 and 3.5 h later and then every 2. Geriatric Use: Patients over 65 years, particularly those with hypertension, may be at increased risk for developing hypotension while undergoing spinal anesthesia with Bupivacaine Spinal (see PRECAUTIONS, General and ADVERSE REACTIONS, Cardiovascular System)
• Identify and discuss causes of pain in the geriatric patient Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010 Apr;112(4):810‐33. •PMH spinal stenosis with left leg pain and weakness Based on our review of the current literature, the need for better pain management in geriatric patients is readily apparent. Localized nerve blocks present exciting possibilities for achieving anesthesia in geriatric patients while minimizing adverse side effects such as delirium and constipation Spinal anesthesia refers to the technique whereby local anesthetics are administered in the cerebro-spinal fluid in the sub-arachnoid space to achieve regional anaesthesia in cases where general anaesthesia is not required or recommended. It results in anesthesia in the umbilical region targeted according to the nerve supply SPINAL anesthesia is often used for surgical repair of traumatic hip fracture, a procedure largely restricted to the geriatric population. These patients have a particularly high incidence of hypotension during spinal anesthesia
Conclusion: Post-spinal anesthesia hypotension, nausea, vomiting and shivering in elderly patients were less common after receiving a single preoperative dose of dexamethasone 8 mg IVI than control Background and Objectives. We sought to determine if spinal anesthesia is more difficult to perform in the elderly. Methods. All spinal anesthetics a In conclusion, these current findings suggest that levobupivacaine can be used as a substitute for bupivacaine for spinal anaesthesia in elderly patients ≥65 years of age undergoing elective TUR-P or TUR-M operations. In our opinion, hyperbaric bupivacaine is the preferred option for operations of short duration Sum DC, Chung PC. Plasma lidocaine level during spinal or epidural anesthesia in geriatric patients. Ma Zui Xue Za Zhi. 1993;31:59-63. CAS PubMed Google Scholar 13. Ledan C, Collet D, Vincelot A, Debord J, Lachatre G, Feiss P. Pharmacokinetics of epidural or intrathecal bupivacaine in elective cesarean section Davis FM, Woolner DF, Frampton C (1987) : Prospective multicentre trial of mortality following general or spinal anaesthesia for hip fracture surgery in the elderly. Br J Anaesth; 59: 1080. Edwards AE, Seymour DG, McCarthy JM (1996): A 5-year survival study of general surgical patients aged 65 years and over
Abstract: Elderly patients with co-morbidities have an increased risk of perioperative mortality and morbidity from anaesthesia. Here is a case report of one such patient who underwent hemiarthroplasty under continous spinal anaesthesia. This technique was advantageous over single shot spinal , epidural and general anaesthesia Spinal anaesthesia (SA) is the most commonly used anesthetic technique for transurethral resection of prostate (TURP) surgery in geriatric patient population.Many geriatric patients have coexisting cardiac or pulmonary diseases, so it's very important to limit the distribution of the block to prevent the possible hemodynamic and pulmonary adverse effects 1. Introduction. Spinal anesthesia induces a sympathetic block that may cause hypotension .In elderly patients, increased baseline sympathetic activity is common with reduced baroreceptor activity .Hypotension has been reported in 5% to 80% of elderly patients, depending on the definition and level of sensory block , ,. As the hemodynamic response is modulated by the autonomic nervous system. Postoperative 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.This study was planned to compare the effects of general and spinal anesthesia on the prevalence of POCD and delirium.A single-blind non-randomized clinical trial
complications, particularly in elderly patients. We hypothesized that ultrasound guidance may reduce the need for redirection (s), the associated discomfort, and complications in conventional landmark-guided paramedian spinal anesthesia. Methods: A total of 70 patients >65 years of age, undergoing total knee or hip arthroplasty, were randoml For elderly patients undergoing surgery for hip fracture, complication rates and length of hospital stay are similar whether they receive general or spinal anesthesia, according to a new study spinal anesthesia. Prior to initiating a spinal block, carefully wash your hands. The patient should be attached to standard monitors including ECG, blood pressure, and pulse oximetry. Record an initial set of vital signs. Preload the patient with 1-1.5 liters of crystalloid intravenous solution Background: Hypotension is common during spinal anesthesia (SA) and is caused by a decrease in systemic vascular resistance (SVR) and/or cardiac output (CO). The effect of the dose of bupivacaine administered intrathecally on the changes in CO in elderly patients is largely unknown. This study investigated the hemodynamic effect of SA in. Oxygen saturation should be closely monitored when obese or elderly patients, or those with mar-ginal pulmonary reserve, are placed in the lithotomy or Trendelenburg position. 2 . Regional anesthesia— Both epidural andspinal blockade provide satisfactory anes thesia for cystoscopy
of geriatric patients to predict hypotension after spinal anesthesia. Materials and Methods Patient selection and study design All types of orthopedic and general surgery operations to be operated with spinal anesthesia were included in the study group. *Corresponding Author: Ahmet Yuksek, Bozok University, Department o The effect of ultrasonographic measurement of vena cava inferior diameter on the prediction of post-spinal hypotension in geriatric patients undergoing spinal anesthesia. Yusuf Aslan Department of Anesthesiology and Reanimation, University of Health Sciences, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey