Geriatric Anesthesia

Sieber, Frederick E.; Pauldine, Ronald

doi:10.1016/b978-0-443-06959-8.00071-6

Cited by 20 publications

(25 citation statements)

References 179 publications

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“…21 Owing to this, ischaemiareperfusion injury may bring more severe pulmonary complications and may be more dangerous in older than in younger patients. 6 Baltalarli et al 22 reported a significant increase in pulmonary interstitial neutrophilic infiltration and haemorrhage in an experimental model of ischaemiareperfusion injury in the lower extremities of rats. In this experiment, however, both iloprost and vitamin C prevented these pulmonary changes and increased PaO 2 .…”

Section: Discussionmentioning

confidence: 99%

“…5 Ageing is associated with progressive loss of functional reserve in major organ systems and elderly patients usually have concurrent cardiopulmonary diseases such as hypertension, diabetes mellitus, chronic lung disease and myocardial ischaemia. 6 Moreover, in recent years, tourniquets are usually applied sequentially in bilateral TKR arthroplasty and may cause sequential ischaemiareperfusion injury. Thus, following bilateral TKR surgery, elderly patients have an increased need for blood transfusions and have higher rates of post-operative intensive care unit admission and mortality, compared with younger patients.…”

Section: Introductionmentioning

confidence: 99%

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Effect of High-Dose Vitamin C on Oxygen Free Radical Production and Myocardial Enzyme after Tourniquet Ischaemia–Reperfusion Injury during Bilateral Total Knee Replacement

2010

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This study investigated the effects of highdose vitamin C on oxygen free radical production and cardiac enzymes after tourniquet application and ischaemiareperfusion injury during bilateral total knee replacement (TKR) in elderly patients. In the vitamin C (VC) group (VC group, n = 16), during surgery, patients received a priming bolus of 0.06 g/kg vitamin C with 100 ml saline followed by 0.02 g/kg vitamin C mixed with 30 ml saline, intravenously. The control group (n = 16) received no intra-operative vitamin C. In the VC group, malondialdehyde levels were lower, and arterial oxygen tension and mean blood pressure were higher, than in controls after post-operative deflation of both knee tourniquets. Troponin I levels were lower in the VC group than in controls 8 h postoperation.Administering high-dose vitamin C during bilateral TKR could prevent oxygen free radical production and a decline in arterial oxygen tension and mean blood pressure induced by ischaemia-reperfusion injury, thereby protecting the myocardium.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of High-Dose Vitamin C on Oxygen Free Radical Production and Myocardial Enzyme after Tourniquet Ischaemia–Reperfusion Injury during Bilateral Total Knee Replacement

2010

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“…In the aged, functional disorders arising from the stiffened heart and blood vessels, decreased response to beta receptor stimulation, autonomic imbalance or dysfunction, and impaired conducting system are common [2]. Although the central nervous system is considered as the primary endpoint of general anesthesia, perioperative central nervous system monitoring is seldom practiced.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, sudden blood pressure fluctuation can be fatal to the aged even leading to cardiac or brain ischemia. Furthermore, various accompanying diseases may endanger the aged during anesthesia and perioperative period [2]. Inflation and deflation of a pneumatic tourniquet during surgery induces miscellaneous alterations in patient's hemodynamic and metabolic status.…”

Section: Introductionmentioning

confidence: 99%

The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery

Song

Kim

2012

Korean J Anesthesiol

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BackgroundInflation and deflation of a pneumatic tourniquet used in total knee replacement surgery induces various changes in patient's hemodynamic and metabolic status, which may result in serious complications, especially in aged patients. Near-infrared spectroscopy (NIRS) is a monitoring device designed to estimate the regional cerebral oxygen saturation. We evaluated the effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery, using NIRS.MethodsTwenty-eight American Society of Anesthesiologists physical status I or II patients, over the age of sixty-five years undergoing total knee replacement surgery, were included. Under general anesthesia, the mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV), and regional cerebral oxygen saturation (rSO2) were recorded before induction of anesthesia and every 2 min after tourniquet deflation for 20 min. Arterial blood gas analysis was performed 5 min before, in addition to 0, and 10 min after tourniquet deflation.ResultsThe decrease of rSO2 was not significant during 20-min deflation period. MAP, CO and SV showed significant decrease during 2 to 12, 4 to 6 and 2 to 6-min period after tourniquet deflation, respectively (P < 0.05). There was no relationship between a maximal decrease of MAP and rSO2.ConclusionsIn aged patients undergoing total knee replacement surgery under general anesthesia, tourniquet deflation caused significant changes in hemodynamic and metabolic status, but not in regional cerebral oxygen saturation. It is recommended to monitor neurologic status, as well as hemodynamic and metabolic status to avoid serious complications, especially in aged patients.

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“…Therefore, issues concerning anesthetic methods and regulation of the stress reactions remain challenging and a focus of discussion in perioperative management for the elderly. Since remifentanil has an instant effect and rapid elimination that are not influenced by age or the functions of the liver and kidneys, and does not result in delayed recovery or respiratory depression after a continuous infusion, it has been extensively used in target-controlled infusion (TCI) for elderly patients (1–3). However, remifentanil readily causes postoperative acute pain which induces restlessness and stress reactions during recovery (4–6).…”

Section: Introductionmentioning

confidence: 99%

Effects of different doses of sufentanil and remifentanil combined with propofol in target-controlled infusion on stress reaction in elderly patients

Hu¹,

Pan²,

Li³

et al. 2013

Experimental and Therapeutic Medicine

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The current study aimed to observe the effects of sufentanil and remifentanil combined with propofol in target-controlled infusion (TCI) on perioperative stress reaction in elderly patients. A total of 80 elderly patients requiring general anesthesia were recruited. They were divided into four groups (each n=20) according to different target concentrations of remifentanil and sufentanil. These target concentrations were: 4 ng/ml remifentanil + 0.2 ng/ml sufentanil for group I; 3 ng/ml remifentanil + 0.3 ng/ml sufentanil for group II; 2 ng/ml remifentanil + 0.5 ng/ml sufentanil for anesthesia induction and post-intubation 3 ng/ml remifentanil + 0.2 ng/ml sufentanil for anesthesia maintenance for group III; and 5 ng/ml remifentanil for anesthesia induction and post-intubation 4 ng/ml remifentanil for anesthesia maintenance for group IV. Norepinephrine (NE), epinephrine (E) and angiotensin II (Ang II) levels in plasma were measured prior to the induction of anesthesia, as well as at several different time-points following surgery. The numbers of intraoperative severe hemodynamic fluctuation, postoperative eye-opening and extubation time, and post-extubation restlessness and pain scores were recorded. Group IV had a larger circulation fluctuation control number and higher levels of NE, E and Ang II at 3 h after surgery than any other group (P<0.01). Although group IV had shorter postoperative eye-opening and extubation times compared with the other groups (P<0.05), it also had higher restlessness and pain scores (P<0.01). The combined use of sufentanil and remifentanil stabilizes perioperative hemodynamics and reduces stress hormone levels.

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Geriatric Anesthesia

Cited by 20 publications

References 179 publications

Effect of High-Dose Vitamin C on Oxygen Free Radical Production and Myocardial Enzyme after Tourniquet Ischaemia–Reperfusion Injury during Bilateral Total Knee Replacement

Effect of High-Dose Vitamin C on Oxygen Free Radical Production and Myocardial Enzyme after Tourniquet Ischaemia–Reperfusion Injury during Bilateral Total Knee Replacement

The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery

Effects of different doses of sufentanil and remifentanil combined with propofol in target-controlled infusion on stress reaction in elderly patients

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