Geriatric neuroanesthesia: the retrospective study of 158 patients

Objective: Geriatric patients have the highest mortality and morbidity rates in the adult surgery population. Due to the comorbidities, it is not surprising that the mortality rates are high. In this study, a group of neurosurgery patients who are 65 years old and older were analyzed retrospectively.
Material and Methods: The age, sex, diagnose, age-related disease existence, type of operation, need emergence or elective situation, Glasgow Coma Scale value, operation time, application of arterial cannule, central venous catheter and gastric tube, intraoperative blood transfusion, intraoperative antihypertensive use and postoperative intensive care unit stay of the 65 years old and older nerosurgery patients, who had an operation for intracranial pathologies in the years between 2009 and 2010, were reached. The rates of sedoanalgesia performance, difficult airway, pneumothorax and mortality rates were recorded.
Results: 2567 patients were operated by the department of neurosurgery in the years of 2009 and 2010. 158 (6.1%) of these patients were in 65 years and elder age group. 66.5% of these patients were scheduled electively. The most common indication of operation was intracranial tumor with 36.1% rate. The hypertension, which was antihypertensive use needed, occured in 29% of these patients. Intraoperative blood transfusion was needed in 20.9% rate. 74.1% of these cases had postoperative intensive care unit stay. Mortality rate was 12.7%. Central venous catheterization was performed to 35.4% of the patients and pneumothorax occured in only 1.3% of them. The difficult airway was seen in the rate of 1.3%. Mean Glascow Coma Scale was 13.05±3.73 and mean operation time was 152.88±74.5 minutes.
Conclusion: The carefully performed preoperative evaluation, appropriate anesthetic management, rapid and atraumatic operation would help to reduce the perioperative complications in geriatric patients. The age is not a handicap alone by itself in geriatric neurosurgery patients, whose risk factors are managed appropriately.

Geriatrik nöroanestezi: 158 hastanýn retrospektif olarak incelenmesi

Amaç: Yaþlý hastalar eriþkin cerrahi nüfusun en yüksek mortalite ve morbidite oranýna sahip hasta grubudur. Önceden var olan yandaþ hastalýklar nedeni ile ölüm oranýnýn yüksek olmasý sürpriz deðildir. Bu çalýþmada hastanemizde 65 ve üzeri yaþ grubunda nörocerrahi uygulanan hastalarýn retrospektif olarak deðerlendirilmesi amaçlandý.
Gereç ve Yöntem: 2009-2010 yýlýnda intrakraniyal patolojiler nedeni ile opere edilen 65 yaþ ve üzeri nörocerrahi hastalarýnýn, yaþ, cinsiyet, Glaskow Koma Skalasý, operasyon süresi, tanýlarý, arter kateterizasyonu, santral ven kateterizasyonu, nazogastrik tüp varlýðý, vakalarýn acil ya da elektif olduðu, intraoperatif kan replasmaný, intraoperatif antihipertansif uygulamasý varlýðý, postoperatif yoðun bakým takibi olup olmadýðý, mevcut olan yandaþ hastalýklarý ile ilgili kayýtlara ulaþýldý. Sedo-analjezi uygulamasý, güç entübasyon, pnömotoraks ve mortalite oranlarý kaydedildi.
Bulgular: 2009-2010 yýlýnda, beyin cerrahisi kliniði tarafýndan 2567 hastaya cerrahi giriþim uygulanmýþtý. Bu hastalardan 158 (%6.1)’i 65 yaþ ve üzerinde idi. Vakalarýn %66.5’i elektif olarak planlanmýþtý. En sýk opere edilen vaka %36.1 oranýnda intrakraniyal tümördü. Vakalarýn %29’unda intraoperatif antihipertansif kullanýmýný gerektirecek hipertansif atak saptandý. %20.9 oranýnda intraoperatif kan replasmanýna ihtiyaç duyuldu. Vakalarýn %74.1’i postoperatif yoðun bakým ünitesinde takip edildi. Mortalite oraný %12.7 idi. Hastalarýn %35.4’ünde santral venöz kateter takýldý, yalnýzca %1.3’ünde pnömotoraks geliþti. %1.3 oranýnda zor entübasyon görüldü. Glaskow Koma Skalasý ortalamasý
13.05±3.73 ve ortalama operasyon süresi 152.88±74.5 dakika idi.
Sonuç: Dikkatli bir preoperatif hazýrlýk, uygun bir anestezi yöntemi, hýzlý ve atravmatik bir operasyon yaþlý hastalarda perioperatif komplikasyonlarý azaltmaya yardýmcý olacaktýr. Risk faktörleri uygun þekilde yönetilen nörocerrahi vakalarýnda yaþ, tek baþýna bir engel oluþturmaz.