Combined subarachnoideal-extradural anesthesia for high-risk patients during surgery on the musculo-skeletal system.
Background. Patients in advanced age undergoing surgery for musculo-skeletal disorders are at risk for failure of vital systems under anesthesia. Thus the choice of anesthetic technique for high-risk patients can have a vital impact on treatment outcome. Material and method. Our research involved 344 patients ranging in age from 69 to 93 (mean 76.4 +/- 7.8) at high risk during extensive orthopedic surgery on the lower limbs. The patients were divided into three groups depending on the anesthetic technique used: Group I - general anesthesia with esophageal intubation or laryngeal mask; Group II - subarachnoid anesthesia; and Group III - combined subarachnoid-extradural anesthesia. The Goldman heart risk and ASA anesthesia risk were determined for each patient. The frequency and type of post-operative complications were also specified. Results. Altogether complications occurred in 15.6% of the patients: 6.1% in Group I, 6.8% in Group II, and 2.9% in Group III. Acute myocardial ischemia and infarct occurred only in patients with high Goldman indices. Pulmonary complications were seen in groups I and II, but not in Group III. Conclusions. Combined subarachnoid-extradural anesthesia enables deeper anesthesia during a prolonged operation, and thus makes it possible to avoid general anesthesia. The post-surgical application of continuous extradural analgesia using bupivacaine with phentanyl enables the introduction of respiratory rehabilitation and rapid mobilization, reducing the number of cardiac and pulmonary complications, and by the same token shortening the duration of hospitalization.
Grabowska-Gaweł
Anna
A