.: ORİJİNAL ARAŞTIRMA
Spinal Anesthesia versus General Anesthesia in Elderly Patients Undergoing Lumbar Instrumentation: A Retrospective Study
Lomber Enstrümantasyon Uygulanan Yaşlı Hastalarda Spinal Anestezi ile Genel Anestezinin Karşılaştırması: Retrospektif Çalışma
Turkiye Klinikleri J Anest Reanim. 2021;19(3):105-13
doi: 10.5336/anesthe.2021-84364
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Spine surgery poses serious risks in elderly patients due to long operating time and massive blood loss. The aim of the study was to evaluate whether anesthesia techniques (general versus spinal) would have an effect on perioperative outcomes in patients older than 65 years who underwent lumbar instrumentation. Material and Methods: A retrospective review was performed using hospital's database after ethics committee approval. Patients with American Society of Anesthesiologists physical status I-III and aged between 65- 90 years were included in the study who underwent elective primary lumbar instrumentation (1-5 levels) surgery were included in the study. Primary outcome measures were perioperative blood loss, blood transfusion requirement and postoperative pain relief. Secondary outcome measures were hospital discharge time and complications. Results: Forty-five patients received general anesthesia (Group GA) using inhalational sevoflurane combined with intravenous remifentail infusion and 44 patients received spinal anesthesia (Group SA). Blood loss was higher in Group GA than Group SA (470.8±91.1 mL vs. 387.8±100.5 mL, p=0.02). More patients in the Group GA were received packed red blood cell transfusion (16.4% vs. 9.1%, p=0.02). Pain scores were higher (5.6±1.1 vs. 4.0±1.8, p=0.02), in Group GA. Hospital discharge time was longer (4.0±1.0 days vs. 3.0±0.6 days; p=0.02) and complication rate was higher in Group GA (61.8% vs. 29.5%, p=0.01). The most common complication was postoperative nausea and vomiting (18.1%). Conclusion: It is concluded that SA may be performed as a safe and effective alternative for GA in older adults undergoing lumbar instrumentation.
Keywords: Anesthesia; aged; orthopedic procedures; lumbar vertebrae
Objective: Spine surgery poses serious risks in elderly patients due to long operating time and massive blood loss. The aim of the study was to evaluate whether anesthesia techniques (general versus spinal) would have an effect on perioperative outcomes in patients older than 65 years who underwent lumbar instrumentation. Material and Methods: A retrospective review was performed using hospital's database after ethics committee approval. Patients with American Society of Anesthesiologists physical status I-III and aged between 65- 90 years were included in the study who underwent elective primary lumbar instrumentation (1-5 levels) surgery were included in the study. Primary outcome measures were perioperative blood loss, blood transfusion requirement and postoperative pain relief. Secondary outcome measures were hospital discharge time and complications. Results: Forty-five patients received general anesthesia (Group GA) using inhalational sevoflurane combined with intravenous remifentail infusion and 44 patients received spinal anesthesia (Group SA). Blood loss was higher in Group GA than Group SA (470.8±91.1 mL vs. 387.8±100.5 mL, p=0.02). More patients in the Group GA were received packed red blood cell transfusion (16.4% vs. 9.1%, p=0.02). Pain scores were higher (5.6±1.1 vs. 4.0±1.8, p=0.02), in Group GA. Hospital discharge time was longer (4.0±1.0 days vs. 3.0±0.6 days; p=0.02) and complication rate was higher in Group GA (61.8% vs. 29.5%, p=0.01). The most common complication was postoperative nausea and vomiting (18.1%). Conclusion: It is concluded that SA may be performed as a safe and effective alternative for GA in older adults undergoing lumbar instrumentation.
Keywords: Anesthesia; aged; orthopedic procedures; lumbar vertebrae
ÖZET
Amaç: Spinal cerrahi, uzun ameliyat süresi ve masif kan kaybı nedeniyle yaşlı hastalarda ciddi riskler oluşturmaktadır. Çalışmamızın amacı, lomber enstrümantasyon uygulanan 65 yaş üstü hastalarda, anestezi tekniklerinin (genel ve spinal), perioperatif sonuçlar üzerinde bir etkisinin olup olmadığını değerlendirmektir. Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra hastanenin veri tabanı kullanılarak geriye dönük bir inceleme yapıldı. Amerikan Anestezistler Derneği fiziksel durum I-III olan, 65-90 yaş arası ve elektif primer lumbar enstrumentasyon (1-5 seviye) cerrahisi uygulanan hastalar çalışmaya alındı. Birincil sonuç ölçümleri; kan kaybı miktarı, kan transfüzyonu gerekliliği ve postoperatif analjeziydi. İkincil sonuç ölçümleri; hastaneden taburculuk süresi ve perioperatif komplikasyonlardı. Bulgular: Kırık beş hastaya sevofluran inhalasyonu ile intravenöz remifentanil infüzyonunun kombine edildiği genel anestezi (Grup GA) ve 44 hastaya spinal anestezi (Grup SA) uygulanmıştı. Kan kaybı miktarı; Grup GA'daki hastalarda (470,8±91,1 mL), Grup SA'dakilere göre (387,8±100,5 mL) daha yüksek bulundu (p=0,02). Eritrosit transfüzyon oranı Grup GA'da daha fazlaydı (%16,4'e karşı %9,1; p=0,02). Grup GA'daki hastalarda Grup SA'dakilere göre ağrı skorları daha yüksek (5,6±1,1 vs. 4,0±1,8, p=0,02) bulundu. Grup GA'da hastaneden taburcu olma süresi Grup SA'ya göre daha fazlaydı (4,0±1,0 güne karşı 3,0±0,6 gün; p=0,02). Grup GA'da (%61,8) komplikasyon oranı Grup SA'ya (%29,5) göre daha yüksekti (p=0,01). En sık komplikasyonlar postoperatif bulantı ve kusmaydı (%18,1). Sonuç: SA'nın lomber enstrümantasyon uygulanan yaşlı hastalarda GA'ya göre güvenli ve etkili bir alternatif olarak uygulanabileceği sonucuna varıldı.
Anahtar Kelimeler: Anestezi; yaşlı; ortopedik prosedürler; lumbar vertebra
Amaç: Spinal cerrahi, uzun ameliyat süresi ve masif kan kaybı nedeniyle yaşlı hastalarda ciddi riskler oluşturmaktadır. Çalışmamızın amacı, lomber enstrümantasyon uygulanan 65 yaş üstü hastalarda, anestezi tekniklerinin (genel ve spinal), perioperatif sonuçlar üzerinde bir etkisinin olup olmadığını değerlendirmektir. Gereç ve Yöntemler: Etik kurul onayı alındıktan sonra hastanenin veri tabanı kullanılarak geriye dönük bir inceleme yapıldı. Amerikan Anestezistler Derneği fiziksel durum I-III olan, 65-90 yaş arası ve elektif primer lumbar enstrumentasyon (1-5 seviye) cerrahisi uygulanan hastalar çalışmaya alındı. Birincil sonuç ölçümleri; kan kaybı miktarı, kan transfüzyonu gerekliliği ve postoperatif analjeziydi. İkincil sonuç ölçümleri; hastaneden taburculuk süresi ve perioperatif komplikasyonlardı. Bulgular: Kırık beş hastaya sevofluran inhalasyonu ile intravenöz remifentanil infüzyonunun kombine edildiği genel anestezi (Grup GA) ve 44 hastaya spinal anestezi (Grup SA) uygulanmıştı. Kan kaybı miktarı; Grup GA'daki hastalarda (470,8±91,1 mL), Grup SA'dakilere göre (387,8±100,5 mL) daha yüksek bulundu (p=0,02). Eritrosit transfüzyon oranı Grup GA'da daha fazlaydı (%16,4'e karşı %9,1; p=0,02). Grup GA'daki hastalarda Grup SA'dakilere göre ağrı skorları daha yüksek (5,6±1,1 vs. 4,0±1,8, p=0,02) bulundu. Grup GA'da hastaneden taburcu olma süresi Grup SA'ya göre daha fazlaydı (4,0±1,0 güne karşı 3,0±0,6 gün; p=0,02). Grup GA'da (%61,8) komplikasyon oranı Grup SA'ya (%29,5) göre daha yüksekti (p=0,01). En sık komplikasyonlar postoperatif bulantı ve kusmaydı (%18,1). Sonuç: SA'nın lomber enstrümantasyon uygulanan yaşlı hastalarda GA'ya göre güvenli ve etkili bir alternatif olarak uygulanabileceği sonucuna varıldı.
Anahtar Kelimeler: Anestezi; yaşlı; ortopedik prosedürler; lumbar vertebra
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