Lu Dongshi, Cai Fei, Ming Yu, Zhang Danqing, Ba Demu, Wu Zhouyang, Zhang Zhao
Department of anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People's Republic of China.
College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, People's Republic of China.
Perioper Med (Lond). 2024 Mar 6;13(1):16. doi: 10.1186/s13741-024-00372-0.
With the aging of human society, more and more elderly patients have to undergo surgery and anesthesia. Clinical observations have indicated from time to time that spinal anesthesia in the elderly appears to last longer than in young people, although there is limited research in this area and the mechanism is unclear at present time. This research work is expected to help understand the decline of local anesthetic metabolism in cerebrospinal fluid of elderly patients so as to help them with precise anesthesia and rapid rehabilitation.
Twenty patients with spinal anesthesia in orthopedic lower limb surgery were selected to study the rate of drug metabolism in cerebrospinal fluid in two age groups, i.e.,18-30 years old and 75-90 years old. Ropivacaine in peripheral blood is used as a probe to reflect the speed of drug metabolism in cerebrospinal fluid. The contents of total Aβ protein and hyaluronic acid in the cerebrospinal fluid were investigated as well.
The equivalent dose of ropivacaine anesthetizes the elderly group for a longer time. The metabolism rate of ropivacaine in an elderly patient was slower than that of a young patient. No significant difference in total Aβ protein between the two groups was observed while hyaluronic acid in the elderly group was significantly higher than that in the young group.
This study shows that the dose of ropivacaine should be reduced when used for anesthesia in elderly patients. The cumulation of ropivacaine and HA appears to imitate the degeneration of central lymphatic circulation metabolism in elderly people.
随着人类社会老龄化，越来越多的老年患者需要接受手术和麻醉。临床观察不时表明，老年患者的脊髓麻醉作用似乎比年轻人持续时间更长，尽管该领域的研究有限，目前机制尚不清楚。这项研究工作有望有助于了解老年患者脑脊液中局部麻醉药代谢的下降情况，从而帮助他们实现精准麻醉和快速康复。
选取20例接受骨科下肢手术脊髓麻醉的患者，研究两个年龄组（18 - 30岁和75 - 90岁）脑脊液中药物代谢速率。以外周血中的罗哌卡因作为探针来反映脑脊液中药物代谢速度。同时研究了脑脊液中总Aβ蛋白和透明质酸的含量。
等效剂量的罗哌卡因使老年组麻醉时间更长。老年患者罗哌卡因的代谢速率比年轻患者慢。两组总Aβ蛋白无显著差异，而老年组透明质酸显著高于年轻组。
本研究表明，罗哌卡因用于老年患者麻醉时应减少剂量。罗哌卡因和透明质酸的蓄积似乎模拟了老年人中枢淋巴循环代谢的退化。
