Observational Study of Nonagenarians Undergoing Emergency, Non-Trauma Surgery

Abstract

almost 3-fold longer than in younger patients. Nonetheless, even in older patients, reversal with sugammadex does not have to be delayed until the second twitch of the TOF response appears or spontaneous respiration is detected, as is the case with neostigmine.There are likely explanations for the longer recovery time in geriatric patients. The onset of action of injected sugammadex is likely dependent on cardiac output and muscle blood flow. Particularly in women, cardiac output decreases moderately with an age-related decline in heart rate. In addition, limb blood flow decreases progressively with advancing age, probably owing to age-related reduced vascular conductance, loss of muscle mass, and decline in oxygen consumption. Age-associated arteriosclerosis also contributes to further reduction in peripheral perfusion. All of these factors would result in a slower increase in the plasma concentration of sugammadex and a slower decline in the plasma concentration of free rocuronium. Thus, free rocuronium molecules cannot diffuse as swiftly from the neuromuscular junction into the plasma.The authors acknowledge that they did not fix the endtidal concentration of sevoflurane to an age-adjusted minimum alveolar concentration value. Rather, they administered a concentration of 1% to 1.5% according to clinical indications. Thus, the elderly patients may have received a larger minimum alveolar concentration dose of sevoflurane than their younger counterparts. Because sevoflurane substantially enhances the effect of neuromuscular blocking agents, it is possible that the efficacy of sugammadex may be diminished during sevoflurane anesthesia, and this possibility warrants further exploration. Clearly, additional studies are needed to determine the effective dose of sugammadex for more rapid reversal of profound neuromuscular block in older patients. Comment by Kathryn E. McGoldrick, MD Disclosure: The author declares no conflict of interest.

Incidence and estimated annual cost of emergency laparotomy in England: is there a major funding shortfall?*

“…Outcome data were significantly worse for older patients, with a fifth of patients failing to leave hospital alive, although it should be noted that ∼82% of 79 ‘extremely old’ patients (> 85 years of age) survived to hospital discharge. Unsurprisingly, given the physiological decline and co‐morbid pathology associated with age, recovery from surgery appeared to be slower in older patients, resulting in longer inpatient stay (similar to findings of previous studies [18, 19]) and financial cost.…”

Anaemia and transfusion in nonagenarians undergoing emergency, non‐traumatic surgery: a prospective observational study

“…The statistical analysis was performed with SPSS 15.0 (SPSS Inc., Chicago, IL, USA). To determine the sample size, we assumed an expected TR of 0·34, based on our preliminary descriptive demographic study of this population (Pelavski et al ., ). As a result, 135 patients yielded a confidence level of 95% and a precision of 8%.…”

The use of urological hospital services by nonagenarians

“…Our in-hospital mortality rate for emergency urological surgery of 18% is more in keeping with data published in 2011 on emergency non-trauma surgery in nonagenarians, where the inhospital mortality rate was 29% for general, vascular and urological surgery combined. 4 Of the 102 operations carried out, 11 were for urological problems and 5 (45%) of these patients died postoperatively. When analysing outcomes of elective procedures, we face the inherent bias of patient selection.…”

“…Pelavski et al reported a 29% in-hospital mortality rate after emergency non-trauma surgery in nonagenarians. 4 In another study looking at 1,063 surgical procedures in nonagenarians, 84 elective urological procedures were performed with a 30-day mortality rate of 3.6%. 5 Additionally, non-operative emergency management of elderly patients consumes significant medical resources.…”