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Geriatric anesthesia

Ersin Ercin, M Gokhan Bilgili, Cihangir Sari, S Hakan Basaran, Bulent Tanriverdi, Erdem Edipoglu, K Mumtaz Celen, Halil Cetingok, Cemal Kural
BACKGROUND: Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes...
August 31, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Rajesh Kumar Singh, J P Chaturvedi, H S Agrawal, Nitesh Agrawal
BACKGROUND: Aging causes progressive deterioration of all the organ systems. Physiological changes of aging and co-morbidities make regional anesthesia a preferred technique for this age group. Regional anesthesia with risk of hypotension and its consequences is fraught with dangers. Peripheral nerve blocks (PNBs) are much safer and give much superior post-op analgesia. The present study was undertaken to perform major lower limb orthopedic surgeries PNBs in geriatric settings. METHODS: A feasibility study was undertaken in patients above age of 60 years admitted for lower limb surgeries to undertake these surgeries under para-vertebral blocks for a period of one year from Mar 2011 to Feb 2012...
July 2016: Medical Journal, Armed Forces India
O Şahap Atik, Fatih I Can, M Selçuk Şenol, Toygun K Eren
A 90-year-old female patient was admitted to our clinic complaining of pain in her left hip which occurred due to fall from a chair. Her medical history included memory loss and mental changes associated with Alzheimer's disease and depression. Patient's cooperation and orientation were weak. Range of motion of the left hip was restricted and painful. Radiographs of the left hip demonstrated subtrochanteric comminuted fracture of femur. Laboratory tests revealed anemia and liver insufficiency. Departments of internal medicine and anesthesiology reported high risk for surgery...
August 2016: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
T S Wildes, A C Winter, H R Maybrier, A M Mickle, E J Lenze, S Stark, N Lin, S K Inouye, E M Schmitt, S L McKinnon, M R Muench, M R Murphy, R T Upadhyayula, B A Fritz, K E Escallier, G P Apakama, D A Emmert, T J Graetz, T W Stevens, B J Palanca, R L Hueneke, S Melby, B Torres, J Leung, E Jacobsohn, M S Avidan
INTRODUCTION: Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium...
2016: BMJ Open
Sushila Murthy, David Lerner Hepner, Zara Cooper, Houman Javedan, Lauren Jan Gleason, John H Chi, Angela Maria Bader
The decision to pursue surgery is often complicated in older adults. A multidisciplinary, shared approach to decision-making may improve communication between patients and their providers and facilitate complex risk assessment. We describe a case of an older adult presenting for complex surgery in which the preoperative anesthesia clinic visit was used to facilitate involvement of the geriatrics service. This multidisciplinary approach allowed for re-evaluation and reiteration of risks and benefits, in-depth discussion of the patient's values and goals, and recommendations for care teams downstream in the patient's surgical pathway to ensure treatment consistent with patient goals and clinical recommendations...
July 15, 2016: A & A Case Reports
Ozkan Onal, Gulten Ozgun
BACKGROUND: Elderly patients constitute the majority of patients undergoing treatment in the intensive care unit (ICU). Patients over the age of 65 account for 42%-52% of admission to ICU. Previous studies have shown that malnutrition is an important factor influencing the prognosis in intensive care. OBJECTIVES: In this study, the effect of body mass index (BMI) and albumin values at first admission to the ICU on the course and prognosis of geriatric patients were investigated...
February 2016: Anesthesiology and Pain Medicine
Thomas J Luger, Markus F Luger
Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification...
April 2016: Zeitschrift Für Gerontologie und Geriatrie
Michael W Rich, Deborah A Chyun, Adam H Skolnick, Karen P Alexander, Daniel E Forman, Dalane W Kitzman, Mathew S Maurer, James B McClurken, Barbara M Resnick, Win K Shen, David L Tirschwell
The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials, and virtually all trials have excluded older patients with complex comorbidities, significant physical or cognitive disabilities, frailty, or residence in a nursing home or assisted living facility...
May 24, 2016: Journal of the American College of Cardiology
Mustafa Aldemir, Halit Buğra Koca, Elif Doğan Bakı, Görkem Çarşanba, Nilgün Öztürk Kavrut, Ali Sait Kavaklı, Fahri Adalı, Mustafa Emmiler, Osman Tansel Darçın
OBJECTIVE: Recent conflicting studies on the renal effects of N-acetyl cysteine (NAC) after cardiac surgery have been published. The aim of this study was to evaluate the renal effects of NAC using neutrophil gelatinase-associated lipocalin (NGAL) blood levels in elderly patients undergoing coronary artery bypass grafting (CABG). METHODS: This randomized, double-blinded, placebo-controlled study was conducted among geriatric patients (>65 years) scheduled to undergo CABG...
November 25, 2015: Anatolian Journal of Cardiology
C Zhang, C Li, Z Xu, S Zhao, P Li, J Cao, W Mi
Postoperative cognitive dysfunction (POCD) is an important complication following major surgery and general anesthesia in older patients. However, the etiology of POCD remains largely to be determined. It is unknown how surgical stress and psychological stress affect the postoperative learning and memory function in geriatric patients. We therefore established a pre-clinical model in aged C57BL/6 mice and aimed to investigate the effects of surgical stress and psychological stress on learning and memory function and the possible roles of the protein kinase B/mammalian target of rapamycin (AKT/mTOR) pathway...
April 21, 2016: Neuroscience
M Coburn, A B Röhl, M Knobe, A Stevanovic, C Stoppe, R Rossaint
BACKGROUND: The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high. AIM: This article presents an overview of the perioperative management of elderly trauma patients in order to improve the perioperative outcome of these high risk patients. MATERIAL AND METHODS: A literature search was carried out focusing on the latest developments in the field of elderly trauma patients in order to present guidance on preoperative, intraoperative and postoperative anesthesiological management...
February 2016: Der Anaesthesist
Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar
Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation...
2015: Local and Regional Anesthesia
Eun Mi Kim, Min-Soo Kim, Bon-Nyeo Koo, Jeong-Rim Lee, Young Sub Lee, Jae Hoon Lee
BACKGROUND: The elderly have been reported to show anatomical and physiologic changes in the upper airway, which might affect the supraglottic airway (SGA) performance in geriatric populations. This study aimed to evaluate the clinical efficacy of the classic laryngeal mask airway (LMA-C) in the elderly compared with young adult patients. METHODS: Fifty patients aged 65-85 years (elderly group) and 50 patients aged 20-40 years (young group) who were scheduled for surgery using the LMA-C for general anesthesia were enrolled in this prospective, non-randomized, comparative study...
December 2015: Korean Journal of Anesthesiology
Andrew Marcantonio, Brandon Steen, Michael Kain, Kasey-Jean Bramlett, John F Tilzey, Richard Iorio
PURPOSE: The purpose of this study was to evaluate preoperative transthoracic echocardiography (TTE) on cardiac intervention, length of stay (LOS), inpatient mortality, and costs. METHODS: A retrospective series of 43 preoperative TTE and 161 non-TTE (control) hip fracture patients (> 65 years) was reviewed. The data collected included ASA score, comorbidities, indication for TTE, perioperative cardiac intervention, LOS, inpatient mortality, and cost. RESULTS: One of 43 (2...
December 2015: Bulletin of the Hospital for Joint Diseases
Ahmed H Yousry, Pranit N Chotai, Sherif A El Ghazaly, Tamer A Fayyad, Amr A Abdelgawad
INTRODUCTION: Trochanteric fractures are a leading cause of disability among the elderly. Internal fixation is the gold standard treatment. However, it may be challenging in the high-risk population. We present our results using external fixator in trochanteric fractures in the elderly. PATIENTS AND METHODS: During 2005-2012, twenty-three high-risk elderly patients (average age 70 years) with trochanteric fracture were managed using percutaneous external fixation (EF)...
December 2015: Journal of Orthopaedics
Tyler Chesney, Sergio A Acuna
Populations are aging worldwide, people are living longer, and the surgical needs of elderly patients are rising. Laparoscopic techniques have become more common with improved training, surgeon skill and evidence of improved outcomes. Benefits of laparoscopy include decreased blood loss, postoperative pain, and hospital length of stay; improved mobilization, quicker return to normal activity; and fewer pulmonary, thrombotic, and abdominal wall complications. Indeed, for many common pathologies laparoscopy has become the gold standard, unless contraindicated...
September 2015: Annals of Medicine and Surgery
Carla C Moreira, Alik Farber, Jeffrey A Kalish, Mohammad H Eslami, Sebastian Didato, Denis Rybin, Ghoerghe Doros, Jeffrey J Siracuse
OBJECTIVE: Patients undergoing major lower extremity amputations are at risk for a wide variety of perioperative complications. Elderly patients with any functional impairment have been shown to be at high risk for these adverse events. Our goal was to determine the association between the type of anesthesia-general anesthesia (GA) and regional/spinal anesthesia (RA)-on perioperative outcomes after lower extremity amputation in these elderly and functionally impaired patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data set (2005-2012) was queried to identify all patients aged ≥75 years with partial or total functional impairment who underwent major lower extremity amputations...
March 2016: Journal of Vascular Surgery
Adam T Phillips, Stacie Deiner, Hung Mo Lin, Evie Andreopoulos, Jeffrey Silverstein, Matthew A Levin
PURPOSE: Geriatric patients are more sensitive to the anesthetic effects of propofol and its adverse effects, such as hypotension, than is the general population; thus, a reduced dose (1-1.5 mg/kg) is recommended for the induction of anesthesia. The extent to which clinicians follow established dosing guidelines has not been well described. Therefore, we investigated the prevalence of propofol overdose in the elderly population to determine whether propofol overdose occurs and is associated with increased hypotension and 30-day mortality...
December 1, 2015: Clinical Therapeutics
Yujie Wu, Zhongyong Shi, Meijuan Wang, Yingbo Zhu, Cheng Li, Guodong Li, Edward R Marcantonio, Zhongcong Xie, Yuan Shen
BACKGROUND: Postoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown. METHODS: We therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75...
2015: PloS One
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