Journal: J Clin Anesth 20(6):452-454, 2008. 17 References
Reprint: Department of Anaesthesiology; Ondokuz Mayis University School of Medicine, 55139 Kurupelit, Samsun, Turkey (S Karacalar, MD)
Faculty Disclosure: Abstracted by J. Joyce, who has nothing to disclose.
Age is generally considered an independent risk factor for surgical complications and death. Elderly patients often have concomitant medical problems, and functional capacity of organs decreases with aging. The impact of anesthetic choice on mortality and morbidity is not definitive.
The use of a single-shot unilateral spinal block with a specific mixture of bupivacaine and fentanyl in two centenarian women is presented. Advanced geriatric patients are an increasingly common part of current anesthetic practice. Spinal anesthesia is the most common anesthetic choice for geriatric hip fracture because of hemodynamic stability, reduced blood loss, reduction in thromboembolic complications, and reduced acute confusion. Although widely used, spinal anesthesia is associated with the risk of potential complications, the main one being hypotension related to the sympathetic block.
To minimize the hemodynamic consequences of spinal anesthesia in geriatric patients, titration of the agents via a subarachnoid catheter or a low-dose hyperbaric technique for unilateral block can be chosen. Several studies have reported that unilateral spinal block was superior to bilateral block. Although the use of a single-shot, low-dose local anesthetic for spinal block may limit hypotension, it may not provide acceptable anesthesia. When administered together intrathecally, opioids and local anesthetics have a potent synergistic analgesic effect.
Opioids combined with local anesthetic can result in adequate surgical anesthesia at a dose of local anesthetic that by itself would not create an adequate block. To increase the probability of achieving unilateral spinal anesthesia, low-dose hyperbaric or hypobaric solutions with the patient placed in the lateral decubitus position and low-speed injection have been used. With a patient placed laterally, a hyperbaric solution has a greater effect on the dependent side, whereas a hypobaric solution achieves a higher level on the nondependent side. |
