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How Will You Stop Her Pain? February 2015 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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1 3 5 F E B R U A R Y 2 0 1 5 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E A N E S T H E S I A A L E R T edited by Jim burger W hen it comes to determining appropriate anesthetic doses, your anesthesia providers may be paying more attention to patient ASA ratings than they are to patient age. That's a con- cern, since older patients tend to be more susceptible to hypotension after induction, and to the resultant potential for complica- tions. When researchers at the Yale School of Medicine examined the records of 799 patients 65 years or older who'd had gastrointestinal surgeries, gynecologic-oncology pro- cedures or thoracic procedures, they found that older patients with ASA ratings of 3 or 4 were given less propofol than younger patients, but that those with ratings of 1 or 2 were given the same doses as their younger counterparts. What's more, the doses were typical- ly at the upper limit of recommended dosing for propofol, despite the fact that elderly patients were significantly more likely than younger patients to experience a significant drop in mean arterial pressure after induction. Additionally, average fentanyl doses given to older patients were significantly above the guideline-recommended dosing range. The researchers, who presented their findings (tinyurl.com/mn2ggwn) at last fall's annual meeting of the American Society of Anesthesiologists, concluded that objective assessment and additional dose adjustments are needed to yield "stable hemodynamics" in elderly patients. Older Patients May Be Getting Too Much Anesthesia z PRESSURE'S ONOlder patients are more susceptible to hypotension after induction. Pain Pump Results May Vary ◗Continuous peripheral nerve catheters with pain pumps have a growing number of advocates, but 2 University of Chicago physicians are cautioning practitioners that "suc- cess and intervention rates … may not match (those cited in) published studies." They point out that an oft-cited study (tinyurl.com/onndfbp)of 620 patients (in which only 4.2% required post-operative interventions) excluded patients with obstructive sleep apnea, cardiopulmonary issues, morbid obesity and chronic opioid use.

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