摘要
<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.
<strong>Background:</strong> Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline.<strong> Objective: </strong>To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO<sub>2</sub> (EtCO<sub>2</sub>), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. <strong>Results: </strong>The mean age, weight, BMI of Group A and Group B patients were not significantly different (<em>p</em> > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (<em>p</em> > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (<em>p</em> < 0.001). Mean RR, SpO2, EtCO<sub>2</sub>, PEFR and BHT of both groups were not significantly different (<em>p</em> > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (<em>p </em>< 0.05). <strong>Conclusion: </strong>Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.
作者
Sharmin Ara Begum
A. K. M. Akhtaruzzaman
Dilip Kumar Bhowmick
Debabrata Banik
Md. Afzalur Rahman
A. K. M. Shahidur Rahman
Md. Saydur Rahman
Khandoker Moynul Hasan
Mohammad Kamrul Ahsan
Md. Imrul Islam
Muhammad Shamsul Arefin
Tahmidul Islam
Sharmin Ara Begum;A. K. M. Akhtaruzzaman;Dilip Kumar Bhowmick;Debabrata Banik;Md. Afzalur Rahman;A. K. M. Shahidur Rahman;Md. Saydur Rahman;Khandoker Moynul Hasan;Mohammad Kamrul Ahsan;Md. Imrul Islam;Muhammad Shamsul Arefin;Tahmidul Islam(Department of Anaesthesiology, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh;Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh;Department of Neuro-Anaesthesia, National Institute of Neurosciences and Hospital (NINS), Sher-e-Bangla Nagar, Agargaon, Dhaka, Bangladesh;Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh;Department of Anaesthesia, Asgor Ali Hospital, Dhaka, Bangladesh;Department of Pediatric Surgery, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh;Holy Family Red Crescent Medical College Hospital (HFRCMCH), Dhaka, Bangladesh;Department of Anaesthesiology and Intensive Care Unit (ICU), Rajshahi Medical College Hospital (RMCH), Rajshahi, Bangladesh;Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh)
