Akademik Veri Yönetim Sistemi
Anestezi Dergisi, cilt.26, sa.1, ss.24-32, 2018 (Scopus)
© 2018 Anestezi Dergisi. All rights reserved.Objective: Mortality of geriatric patients undergoing major lower extremity surgery is high because of limited physiological adaptation capacities, the presence of concomitant systemic diseases and risk of embolism. There is no consensus on the safest type of anesthesia for these patients and the opinion related to the choice of general or regional anesthesia is still controversial. We aimed to compare continuous spinal anesthesia (CSA) and general anesthesia (GA) techniques in high risk geriatric patients undergoing major lower extremity surgery in terms of hemodynamic variables and perioperative-postoperative complication rates. Method: Fifty consecutive, aged 65 and above, ASA II-III class, patients with cardiac risk undergoing major lower extremity surgery were included to the study. The patients were randomly divided into two groups as CSA group and GA group. Hemodynamic parameters of patients were recorded every 5 minutes. In group CSA, 2.5 mg of 0.5% isobaric bupivacaine was given by catheter for induction. In every 5 minutes, 2.5mg of bupivacaine (max 10 mg) was added until reaching target level of T10. In group GA, slow induction was performed with 4-6 mg kg-1 thiopental sodium+0.6 mg kg-1 rocuronium br.+ 0.5-1 mcg kg-1 remifentanil to patients. Anesthesia was maintained with 1.5-2.5 % sevoflurane. During the operation, >30% reduction in baseline mean arterial blood pressure was accepted as 'hypotension'. In case of hypotension lasting longer than one minute, iv bolus dose of ephedrine 5 mg was administered. The frequency of ephedrine administration and total dose of ephedrine were recorded in all patients. Results: There was no difference between two groups in terms of hemodynamic profile (heart rate, arterial blood pressures), the incidence of hypotension, the frequency of ephedrine administration and total dose of ephedrine. CSA technique was performed easily and safely to all patients in group CSA. Conclusion: The choice of anesthetic technique should be determined by the anesthesiologist based on the patient's preference, comorbidities, potential postoperative complications and the clinical experience of the anesthesiologists. The overall therapeutic approach to geriatric patients should be multidisciplinary after consultation with orthopedic surgeon, the geriatrician and the anesthesiologist.