Perioperative care in elderly cardiac surgery patients

Abstract

IntroductionSurgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin.AimTo evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients.Material and methodsThe study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009–2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients.ResultsThe mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality).ConclusionsThe implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium.

It is time for enhanced recovery after surgery in cardiac surgery

“…The optimal solution is combined anaesthesia (sevoflurane 0.8-1 MAC; propofol ≥ 3 mg/kg/h; fentanyl 5-15 µg/kg -cumulative dose; rocuronium 0.6-1.0 mg/kg for intubation, 0.075-0.15 maintenance dose) [36]. Such a protocol of anaesthesia was used in the group of patients undergoing cardiac surgical procedures aged > 75 years, and the duration of post-operative mechanical ventilation was shortened by over 10 h [37].…”