Çağıran Zeynep, Vahabi Arman, Özgül Kazım Koray, Aljasim Omar, Karaman Semra, Özkayın Nadir, Aktuğlu Kemal, Sertöz Nezih
Department of Anesthesiology and Reanimation, Ege University School of Medicine, Izmir, Turkey.
Department of Orthopaedics and Traumatology, Ege University School of Medicine, Izmir, Turkey.
Geriatr Orthop Surg Rehabil. 2024 Aug 30;15:21514593241280908. doi: 10.1177/21514593241280908. eCollection 2024.
Aortic stenosis is a cause of mortality or morbidity. It complicates the selection and management of anesthetic procedures. The aim of this study was to evaluate the efficacy, hemodynamic effects and postoperative outcome of unilateral spinal anesthesia in geriatric patients with hip fractures with moderate or severe aortic stenosis.
A retrospective observational study was conducted on geriatric high-risk patients with cardiac conditions who underwent surgery for hip fractures under unilateral spinal anesthesia with low-dose hyperbaric bupivacaine. The study period spanned from January 2018 to December 2021. The inclusion criteria were individuals with moderate to severe aortic stenosis, as defined by the American Heart Association Criteria. Data on demographic information, cardiac pathologies, hemodynamic data, data on motor and sensory block, perioperative complications, and mortality rates at 30th and 180th days were collected.
Mortality rates at the 30th day and 180th day were 8.9% (n:4) and 24.4% (n:11), respectively. T6 level was predominantly obtained level of anesthesia (44.4%). Motor and sensory block formation times averaged 7.6 and 4.8 minutes, respectively. Surgical procedures were performed mostly within 1 hour (66.7%), and complications were rare (11.1% hypotension). Initial analgesic effect showed a rapid resolution, with 64.4% of patients requiring analgesic within the first hour postoperatively.
In elderly patients with moderate to severe aortic stenosis scheduled for hip fracture surgery, we posit that unilateral spinal anesthesia with ultra-low dose is safe and effective option.
主动脉瓣狭窄是导致死亡或发病的原因之一。它使麻醉程序的选择和管理变得复杂。本研究的目的是评估单侧脊髓麻醉在患有中度或重度主动脉瓣狭窄的老年髋部骨折患者中的疗效、血流动力学效应和术后结果。
对接受低剂量高压布比卡因单侧脊髓麻醉下髋部骨折手术的老年高危心脏病患者进行了一项回顾性观察研究。研究期间为2018年1月至2021年12月。纳入标准为符合美国心脏协会标准定义的中度至重度主动脉瓣狭窄患者。收集了人口统计学信息、心脏病变、血流动力学数据、运动和感觉阻滞数据、围手术期并发症以及第30天和第180天的死亡率数据。
第30天和第180天的死亡率分别为8.9%（n = 4）和24.4%（n = 11）。主要麻醉平面为T6水平（44.4%）。运动和感觉阻滞形成时间平均分别为7.6分钟和4.8分钟。手术大多在1小时内完成（66.7%），并发症罕见（低血压11.1%）。初始镇痛效果迅速消退，64.4%的患者在术后第一小时内需要镇痛。
对于计划进行髋部骨折手术的中度至重度主动脉瓣狭窄老年患者，我们认为超低剂量单侧脊髓麻醉是一种安全有效的选择。
