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Quid novi in the eldery patient’s anesthesia
BMC Geriatrics volume 11, Article number: A26 (2011)
Today the availability of new local anesthetics and the use of analgesics, allow the modulation of the analgesia, maintaining a state of consciousness.
An answer to the needs of patients >75 years undergoing surgery is the technique Monitored Anesthesia Care (MAC), defined “the middle land” (Figure 1).
the modulation of the level of analgesia at different stages of surgery due to the availability of analgesic action, but with rapid onset-time
the additional analgesia using local anesthetics with prolonged effect without the use of noradrenaline, dangerous for elderly patients
the consciousness and cooperation of the patient (Table 1).
Materials and methods
With this study we tested the efficacy, safety and limitations of the MAC.
The design of the study was a prospective, double-blind, parallel-group, with 42 patients randomly selected from 87 patients recruited between those eligible for inclusion in the circuit one-day surgery (Table 2)
Two groups were subjected to two different regimes of sedation with propofol and midazolam, pain controlled with remifentanil.
Primary end-point was verifying the level and quality of sedation achieved
Levels of sedation, pain and mental status were assessed using different clinical approaches :
Observational data (Table 5).
We proceeded as follows:
O2 inhalation (SpO2 > 98 and normocapnia)
during surgical manipulation a continuous infusion of remifentanil: 0.03 to 0.06 mg / kg / h was activated
Patients were randomly dichotomized into two arms with two different infusion regimens:
group P (45 patients): starter bolus of 0.5 mg / kg propofol (to fill the central compartment) → P infusion of 1-2 mg / kg / h (to offset the rapid deployment)
group M (41 patients): bolus starter from 0.03 to 0.05 mg / kg midazolam (average dose of 2-4 mg) infusion of 1-2 mg / kg / h
Every 10 m’ scores are recorded, BIS and OAA / S scale.
objective parameters based on Ramsay Scale (Table 6).
The combination midazolam-remifentanil presented a lower synergistic effect compared with propofol-remifentanil. The first fact documented a mean BIS of 62.5 +3 vs. 64.7 +4 midazolam-remifentanil association and has finally, although sporadic, incidents of desaturation content and never > 30%. The evaluation of the kinetic values of BIS, the interesting fact that emerges concerns the values> 70, which represented a significant predictor in the study to better recovery of consciousness, which has helped the fast-traking ongoing day-surgery.
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Lettieri, B., Mingione, M., d’Elia, A. et al. Quid novi in the eldery patient’s anesthesia. BMC Geriatr 11, A26 (2011). https://doi.org/10.1186/1471-2318-11-S1-A26
- Local Anesthetic
- Central Compartment
- Potential Adverse Effect