Lauven P M, Nadstawek J, Albrecht S
Klinik für Anaesthesiologie und Operative Intensivmedizin, Städt. Krankenanstalten Mitte, Bielefeld, Germany.
Drugs Aging. 1993 Nov-Dec;3(6):502-9. doi: 10.2165/00002512-199303060-00004.
Age greater than or equal to 75 years is not a special risk for adverse outcomes after general anaesthesia on its own but an indicator of risk. Biological or physiological age expressed by preoperative health status is much more important than chronological age. The type of anaesthesia seems to play no, or only a minor role. It is, however, most important to reduce the dosage considerably. As a rule of thumb, the dosage should be reduced by 10 to 15% for every decade over the age of 40. In addition, patients must be monitored extensively intra- and postoperatively, ideally in an intensive care setting. The controversy concerning regional versus general anaesthesia should be studied further. Regional anaesthesia techniques like high spinal or epidural anaesthesia that are haemodynamically effective do not reduce morbidity and mortality postoperatively but have the risk of profound hypertension. Peripheral blockades and spinal or epidural anaesthesia without additional sedation may, however, be associated with a reduced incidence of complications. The reduced reserves of geriatric patients demand for experienced anaesthetists and surgeons as well as intense intra- and postoperative monitoring. To secure a short recovery period, we recommend administration of short-acting drugs like propofol, midazolam, alfentanil, vecuronium, atracurium or isoflurane in appropriately reduced dosages.
75岁及以上本身并非全身麻醉后出现不良后果的特殊风险因素，而是一个风险指标。由术前健康状况所体现的生物学或生理年龄比实际年龄更为重要。麻醉类型似乎不起作用，或仅起次要作用。然而，大幅减少剂量最为重要。根据经验法则，40岁以上每增长十岁，剂量应减少10%至15%。此外，必须在术中和术后对患者进行全面监测，理想情况下应在重症监护环境中进行。关于区域麻醉与全身麻醉的争议应进一步研究。诸如高位脊髓麻醉或硬膜外麻醉等对血流动力学有影响的区域麻醉技术并不会降低术后发病率和死亡率，反而有导致严重高血压的风险。然而，外周阻滞以及未加用镇静剂的脊髓或硬膜外麻醉可能会使并发症发生率降低。老年患者储备功能下降，需要经验丰富的麻醉师和外科医生以及加强术中和术后监测。为确保恢复期短，我们建议使用短效药物，如丙泊酚、咪达唑仑、阿芬太尼、维库溴铵、阿曲库铵或异氟烷，并适当减少剂量。
