[Optimization of anesthesia for emergency abdominal surgery in the elderly].
OBJECTIVE
Peroperative haemodynamic profile comparison of two anaesthetic protocols for emergency abdominal surgery of old patients.


METHODS
Non-randomized monocentric study. Patients in the Optimization group were prospectively studied. Anaesthesia was induced by etomidate-succinylcholine and maintained with effect site and end-tidal target controlled administration of remifentanil and desflurane respectively to keep the BIS values between 45 and 55. These patients were matched with retrospectively studied patients constituting the Control group. The latter's were anaesthetized with etomidate-succinylcholine and anaesthesia was maintained by manually controlled administration of sufentanil and desflurane to keep systolic arterial pressure (SAP) within a range of more or less 30% of preoperative baseline SAP.


RESULTS
Twelve patients (86+/-5 yrs) were included in the Optimization group, 11 (86+/-4 yrs) in the Control group. The time spent at a SAP within more or less 30% of baseline values was 92+/-7% and 71+/-29% of total anesthesia time in the Optimization and Control groups respectively (p<0.05). That spent at a SAP less than 15 and 30% of baseline values was 23+/-11% et 3+/-5% of total anaesthesia time in the Optimization group, whereas in the MAN group it was 65+/-21% and 27+/-30% respectively (p<0.05). Desflurane and ephedrine consumption was less in the Optimization group as well as crystalloid or colloid volume loading.


CONCLUSIONS
Anaesthetic agents target controlled administration and/or neurophysiologic depth of anaesthesia monitoring improve the time course of the haemodynamic effects in elderly patients undergoing abdominal surgery in emergency.
Varvat
C
C
Département d'anesthésie-réanimation, hôpital Nord, 42055 CHU Saint-Etienne, Saint-Etienne cedex 2, France.
Passot
S
S
Beauchesne
B
B
Dufraisse
G
G
Molliex
S
S
D000005:Abdomen / Q000601:surgery*; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D000077335:Desflurane; D004632:Emergency Medical Services / Q000379:methods*; D005045:Etomidate; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives; D008297:Male; D009467:Neuromuscular Depolarizing Agents; D010880:Piperidines; D011300:Preoperative Care; D011446:Prospective Studies; D000077208:Remifentanil; D013390:Succinylcholine; D013514:Surgical Procedures, Operative / Q000379:methods*
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D009467:Neuromuscular Depolarizing Agents; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D013390:Succinylcholine; D000077208:Remifentanil; D005045:Etomidate