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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
â——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.