Neuraxial Anesthesia in the Geriatric Patient

Sivevski, Atanas; Karadjova, Dafina; Ivanov, Emilija; Карталов, Андријан

doi:10.3389/fmed.2018.00254

Cited by 15 publications

(8 citation statements)

References 21 publications

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“…Since then opioids have become the most popular adjuvants for intrathecal anaesthetic administration (8) and are widely used as a single dose to provide post-operative analgesia (4). The bene cial analgesic effects of ITM administration have become well recognised (9)(10)(11)(12)(13)(14)(15) and is considered by some to be the gold standard for single-dose neuraxial opioid due to its postoperative analgesic e cacy and prolonged duration of action (16). ITM provides decreased pain intensity and for 24 hours post-operatively with decreased adjuvant analgesic requirements, being particularly evident after abdominal surgery (17).…”

Section: Discussionmentioning

confidence: 99%

Early Warning System triggers in Intensive Care Unit after receiving Intrathecal Morphine: A Retrospective Analysis.

Skelly

Jonker

2021

Preprint

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BackgroundNeuraxial analgesia, including intrathecal morphine(ITM) administration, provides excellent analgesia in the post-abdominal surgery setting. As a corollary, such patients are commonly admitted to HDU/ICU for post-operative monitoring, and as such, bed availability can curtail its use. Reluctance to ward based postoperative care for this cohort is evident. Ward based postoperative care could benefit post-operative analgesic management.MethodsWe reviewed post-operative vital signs constituting the Irish National Early Warning System (INEWS), for general surgical patients admitted to our ICU after ITM administration, as would be undertaken at ward level. Data analysis for a period between January 2015 and August 2018. Inclusion criteria included: abdominal surgery; preoperative ITM and ICU admission post-operatively. Data for the initial 24 hours of ICU admission were obtained, including: AVPU score; respiratory rate(RR); fraction inspired oxygen(FiO2); arterial oxygen saturation(SpO2); heart rate(HR); systolic blood pressure(sBP). Additional measurements include recorded: ITM dose, age, weight, ASA grade, APACHE II Score, visual analogue pain scale scores, analgesic requirements.ResultsThirty patients were included. The ITM dose was 548.3±28.2mcg(mean±SD). Mean maximum constituent INEWS Scores were: 1.7±0.2(RR); 1.5±0.2(SpO2); 1.6±0.3(AVPU); 1.1±0.2(HR); 2.0±0.2(sBP) giving a mean maximum total INEWS score of 4.9±0.3. Four subjects scored ≥7. No patient had INEWS de-escalated for supplemental oxygen and as such the addition of 3 NEWS points for oxygen supplementation would be applied to 96.7% (n=29) of patients. ConclusionsThe current study demonstrates that patients receiving these doses of ITM can exhibit high INEWS scores which would trigger escalation as outlined by the INEWS scoring system if located on a level 1 ward.

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Section: Discussionmentioning

confidence: 99%

Early Warning System triggers in Intensive Care Unit after receiving Intrathecal Morphine: A Retrospective Analysis.

Skelly

Jonker

2021

Preprint

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“…A lower dose of local anesthetic (LA) with adjuvants such as opioids, α2-agonist, NMDA receptor antagonist reduces the chances of cardiovascular complications. [ 9 10 ]…”

Section: Discussionmentioning

confidence: 99%

Comparative study of hemodynamic effects of intrathecal bupivacaine with butorphanol in cardiac and non-cardiac patients

Gupta

Arora

Kaur

et al. 2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: The synergism between intrathecal opioids and low dose local anesthetics makes it possible to achieve reliable spinal anesthesia (SA) with minimal hypotension. The study objective was to compare the hemodynamic effects of reduced dose of 0.5% intrathecal bupivacaine (2mL) with 25 μg butorphanol in cardiac vs non-cardiac patients. Material and Methods: We included sixty patients aged 30-80 years, undergoing infraumbilical surgeries in the study and compared thirty cardiac patients with mild to moderate reduction in left ventricular ejection fraction (LVEF) on 2D echocardiography (Group C) with 30 non-cardiac patients (Group NC) for similar types of surgery. Both the groups received 0.5% bupivacaine 2.0 ml with 25 μg butorphanol. Results: The spinal block characteristics were similar in both groups ( P > 0.05). The blood pressure of the patients in the two groups was comparable till 80 min P > 0.05 after which Group NC had significant increase in blood pressure compared to Group C upto 95 min ( P < 0.05). Similarly, heart rate was comparable until 90 min ( P > 0.05) after which Group NC had significant increase in heart rate versus Group C upto 100 min ( P < 0.05). Eight patients in group C and five patients in group NC showed hypotension. Bradycardia was seen in 4 patients in group C in comparison to only one patient in group NC. Conclusion: We can safely consider spinal anesthesia with 10 mg bupivacaine and 25μg butorphanol in cardiac patients with mild to moderately reduced ejection fraction presenting for infraumbilical non-cardiac surgeries with the advantage of intraoperative hemodynamic stability and adequate postoperative analgesia.

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“…Literature review revealed the efficacy and reduced postoperative side effects of low-dose neuraxial anesthesia in geriatric patients undergoing gynecological surgeries. [ 34 ] A smoother and quicker recovery is achieved by maintaining intraoperative euthermia, euglycemia, and euvolemia as well as avoiding or early removal of tubes and drains. The overall effect is reduced postoperative pain and opioid use.…”

Section: Oncept Of E Nhanced R Ecovery a Fter S Urgerymentioning

confidence: 99%

Enhanced Recovery after Surgery

Gupta

Rane

2021

Journal of Mid-Life Health

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Enhanced recovery after surgery (ERAS) is a multimodal convention first reported for colorectal and gynecologic procedures. The main benefits have been a shorter length of stay and reduced complications, leading to improved clinical outcomes and cost savings substantially. With increase in life expectancy, recent years has shown a significant rise in advanced age population, and similarly, a rise in age-related disorders requiring surgical management. Due to pathophysiological and metabolic changes in geriatric age group with increased incidence of medical comorbidities, there is higher risk of enhanced surgical stress response with undesirable postoperative morbidity, complications, prolonged immobility, and extended convalescence. The feasibility and effectiveness of ERAS protocols have been well researched and documented among all age groups, including the geriatric high-risk population. [1] Adhering to ERAS protocols after colorectal surgery showed no significant difference in postoperative complications, hospital stay, or readmission rate among various age groups. [2] A recent report mentions the safety and benefits following ERAS guidelines with reduced length of stay in elderly patients with short-level lumbar fusion surgery. [3] The concept of prehabilitation has evolved as an integral part of ERAS to build up physiological reserve, especially in geriatric high-risk group, and to adapt better to surgical stress. [4] High levels of compliance with ERAS interventions combined with prehabilitation can be achieved when a dedicated multidisciplinary team is involved in care of these high-risk patients.

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Neuraxial Anesthesia in the Geriatric Patient

Cited by 15 publications

References 21 publications

Early Warning System triggers in Intensive Care Unit after receiving Intrathecal Morphine: A Retrospective Analysis.

Early Warning System triggers in Intensive Care Unit after receiving Intrathecal Morphine: A Retrospective Analysis.

Comparative study of hemodynamic effects of intrathecal bupivacaine with butorphanol in cardiac and non-cardiac patients

Enhanced Recovery after Surgery

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