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Background: Radical cystectomy (RC) is the gold standard therapy in nonmetastatic muscleinvasive bladder cancer and is usually performed under general anesthesia (GA). GA is high risk in most older patients due to comorbidities. Continuous spinal anesthesia (CSA) may be an alternative solution to reduce postoperative morbidity in elderly. The aim of this study was to assess the feasibility, morbidity, and mortality of RC performed under CSA in octogenarian patients. Methods: We retrospectively reviewed data of five frail patients aged ⩾80 who underwent RC in CSA. CSA was achieved starting with 2.5 mg hyperbaric bupivacaine plus 25 µg fentanyl. Postoperative analgesia was achieved through the intrathecal catheter, using continuous delivery of levo-bupivacaine 60 mg plus fentanyl 75 µg in 72 hours. Results: Surgery was completed in all cases in CSA. No patients required postoperative intensive care unit admission. Complications were Clavien I for four in three patients, Clavien II for seven in five patients, and Clavien IIIb for one patient. Postoperative consumption of painkillers was negligible. Oral feeding resumed within 3 days in all cases. The mean postoperative stay was 9.6 days. All patients were alive at 3 months of follow up. Conclusions: Management of muscle-invasive bladder cancer (MIBC) in older patients is becoming an important issue due to the continuous aging of the population. Age should not preclude RC, but careful management is mandatory because perioperative morbidity and mortality are increased in the elderly. Our preliminary results show that CSA and analgesia is a feasible option as an additional way to reduce morbidity and mortality in frail octogenarians who require RC.

Background Limited studies have applied thoracic continuous spinal anesthesia in abdominal surgery, relying exclusively on opioids. This retrospective study analyzes 2 different schemes of thoracic continuous spinal anesthesia and postoperative analgesia in elderly patients undergoing major abdominal surgery. Methods A total of 98 patients aged ≥ 75 years were divided into 2 groups. The control group (60 patients) received bupivacaine plus fentanyl, whereas the study group (38 patients) received bupivacaine plus ketamine and midazolam. Both received analogous postoperative continuous intrathecal analgesia. Several perioperative variables were evaluated. Results Spinal anesthesia was performed without complications in all patients. Doses of noradrenaline administered, incidence of respiratory depression, need for intraoperative sedation, and time to first flatus were significantly reduced in the bupivacaine plus ketamine and midazolam group. Conclusion In a population of frail, elderly patients, thoracic continuous spinal anesthesia with local anesthetic plus midazolam and ketamine was superior to local anesthetic plus fentanyl. In the group receiving local anesthetic plus midazolam and ketamine, the incidence of respiratory depression was reduced, and doses of norepinephrine and intraoperative sedating medications were lower. Intraoperative anesthesia and postoperative analgesia were similar in both groups.

Systemic fluid absorption (FA) is frequent during transurethral surgery. FA occurs through the blood vessels and after a prostatic capsule perforation. When large volumes (>3 L) are absorbed, fluid overload (FO) has the potential to cause severe adverse events. In fact, one the most serious transurethral resection of the prostate (TURP) complications is the TUR-syndrome. It is a systemic manifestation, which occurs after absorption of irrigation fluid (glycine, sorbitol/mannitol) during endoscopic surgery. The signs and symptoms of TUR-syndrome are mainly correlated to FO, acute hypo-osmolality and hyponatremia (glycine, sorbitol/mannitol) and hyperammonemia (glycine) (Hahn, 2006). The introduction of bipolar diathermy and lasers in transurethral surgery allowed the use of normal saline/0.9% sodium chloride (NS) and eliminated the risk of TUR-syndrome. However, FA has also been reported during transurethral laser enucleation of the prostate (Shah, Kausik, Hegde, Shah, & Bansal, 2006). When large volumes of NS are absorbed, FO can be the result. No reports have been published of FO after Thulium laser enucleation of the prostate (ThuLEP). Therefore, we report of on the incidence, sign and symptoms severity of FO in men who underwent ThuLEP.