Perioperative management of elderly patients undergoing surgery with regional anesthesia

Abstract

Regional anesthesia can reduce deep vein thrombosis and pulmonary embolism by suppression of the stress responses caused by surgery via the blocking of the afferent and efferent pathways of nerve conduction. It is also effective for control of acute postoperative pain, and compared to general anesthesia, it reduces bleeding during surgery and postoperative respiratory complications. The functional reserves of important organs are reduced in elderly patients although the progression and degree are different from patient to patient. Thus, it is important that safe and appropriate perioperative care including anesthesia be delivered only after a thorough evaluation of the current status of an elderly patient. In this regard, regional anesthesia is worth performing for elderly patients considering its characteristic advantages over general anesthesia. Peripheral nerve blocks using ultrasound are another alternative in elderly patients who might have difficulty undergoing regional or general anesthesia.

Comparative Analysis of Anesthetic Legal Disputes between Older and Younger Patients Referred to the Korean Society of Anesthesiologists in 2009–2018

“…As older adults often have multiple comorbidities, such as diabetes mellitus, hypertension, and cardiac hypertrophy, they are not only a high-risk group for anesthesia and surgery but also require management in terms of baseline diseases. 9 , 10 ) In addition, anesthesia in geriatric patients must be administered carefully because of their decreased sympathetic response, venous compliance, and cardiac preload; propensity for injury in association with glucose tolerance; diastolic dysfunction; and decline in renal function and mass. 11 ) Indeed, the rate of claims by older patients is about 5–10 times lower than that by younger patients.…”

“…Freelance anesthesiologists may not be sufficiently familiar with a hospital’s facilities to act appropriately in the event of an accident. As peripheral oxygen saturation (SpO 2 ) and EtCO 2 monitoring reduce the incidence rates of mortality and brain death associated with respiratory problems, 10 ) a standard for anesthetic care including sedation is necessary to ensure adequate manpower and equipment essential for anesthesia.…”