Nagamine Yoshiyuki, Godai Kohei, Oki Hiroshi, Kanmura Yuichi
Department of Anesthesiology, Kagoshima Prefectural Ohshima Hospital, 18-1 Nazemanadu, Amami, Kagoshima 894-0015 Japan.
Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan.
JA Clin Rep. 2016;2(1):24. doi: 10.1186/s40981-016-0050-9. Epub 2016 Sep 23.
The anesthetic management of centenarians is challenging, since they have loss of functional reserve in all organs. The mortality rate of 25 % is reported in patients over 100 years old who underwent emergency surgery. The transversus abdominis plane block has been shown to provide effective analgesia in laparoscopic cholecystectomy. A 101-year-old woman was diagnosed with grade I (mild) acute cholecystitis with gallstones. An emergency laparoscopic cholecystectomy was scheduled. The patient had a history of hypertension. The patient's laboratory data showed that she had mild coagulopathy, anemia, thrombocytopenia, and decreased renal function. After induction of general anesthesia, an ultrasound-guided, bilateral subcostal transversus abdominis plane block was performed. Her postoperative course was uneventful. Using the preoperative subcostal transversus abdominis plane block, we were able to avoid hemodynamic instability and to reduce opioid dosage in a centenarian who underwent emergency laparoscopic cholecystectomy under general anesthesia.
百岁老人的麻醉管理具有挑战性，因为他们所有器官的功能储备都有所丧失。据报道，接受急诊手术的100岁以上患者的死亡率为25%。腹横肌平面阻滞已被证明在腹腔镜胆囊切除术中能提供有效的镇痛效果。一名101岁女性被诊断为I级（轻度）急性胆囊炎伴胆结石。计划进行急诊腹腔镜胆囊切除术。该患者有高血压病史。患者的实验室数据显示她有轻度凝血功能障碍、贫血、血小板减少和肾功能下降。全身麻醉诱导后，实施了超声引导下的双侧肋下腹横肌平面阻滞。她的术后过程顺利。通过术前肋下腹横肌平面阻滞，我们得以避免血流动力学不稳定，并减少了一名在全身麻醉下接受急诊腹腔镜胆囊切除术的百岁老人的阿片类药物用量。
