The induction, maintenance, and recovery characteristics of spinal versus general anesthesia in elderly patients.
OBJECTIVE
To compare the induction and recovery profiles of three combinations of general anesthesia when used as an alternative to spinal anesthesia for elderly patients.


METHODS
Randomized, prospective, open-label study.


METHODS
Large referral hospital.


METHODS
100 [ASA physical status I, II, and III] patients over 60 years of age undergoing brief transurethral surgery.


METHODS
In Groups Propofol-Propofol (P-P), Propofol-Isoflurane (P-I), and Propofol-Desflurane (P-D), anesthesia was induced with fentanyl (1 to 2 micrograms/kg i.v.) and propofol (1.0 to 2.0 mg/kg i.v.) and maintained with 70% nitrous oxide in oxygen and either a propofol infusion (75 to 150 micrograms/kg/min) or isoflurane (end-tidal 0.7% to 1.2%) or desflurane (end-tidal 1% to 4%), respectively. After induction, a laryngeal mask airway was placed and spontaneous ventilation was maintained. In Group Spinal (S), 1.5 ml 4% lidocaine (60 mg), in an equal volume of 10% dextrose, was administered intrathecally.


RESULTS
Induction and recovery characteristics were compared. Induction with propofol was technically easier and significantly (medp < 0.0001) faster (4.6 +/- 1.7 min, 4.7 +/- 2.2 min, and 3.8 +/- 1.4 min for Groups P-P, P-I, and P-D, respectively) than induction of spinal anesthesia (9.3 +/- 3.4 min). During the induction period, mean arterial blood pressure and heart rate were significantly higher in Group S. Emergence, extubation, and orientation times were similar among the general anesthesia treatment groups. In Group S, patient-generated pain scores were lower (p < 0.05) and recovery room admission longer (p < 0.001). Time to return to baseline digit symbol substitution test (DSST) scores was marginally improved in Groups P-P and P-D when compared to Group P-I. Postoperative nausea, sleepiness, anxiety, and coordination were unaffected by the treatment modality.


CONCLUSIONS
General anesthesia with propofol and desflurane facilitates shorter induction and recovery times without adversely affecting patient comfort. Therefore, this technique may be preferable to spinal anesthesia for elderly patients undergoing short transurethral surgical procedures.
Fredman
B
B
Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba, Israel.
Zohar
E
E
Philipov
A
A
Olsfanger
D
D
Shalev
M
M
Jedeikin
R
R
D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology; D000077335:Desflurane; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008606:Mental Processes / Q000187:drug effects; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D011468:Prostatectomy; D001749:Urinary Bladder Neoplasms / Q000601:surgery
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D000077335:Desflurane; D007530:Isoflurane; D009609:Nitrous Oxide; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol