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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Anesthetic management of a 137-year-old patient fracture of neck femur</title><author><name sortKey="Nanda, Samridhi" sort="Nanda, Samridhi" uniqKey="Nanda S" first="Samridhi" last="Nanda">Samridhi Nanda</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia, Pt. Madan Mohan Malviya Hospital, New Delhi, India</nlm:aff></affiliation></author><author><name sortKey="Gupta, Anju" sort="Gupta, Anju" uniqKey="Gupta A" first="Anju" last="Gupta">Anju Gupta</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia, Pt. Madan Mohan Malviya Hospital, New Delhi, India</nlm:aff></affiliation></author><author><name sortKey="Kulshreshtha, Amit" sort="Kulshreshtha, Amit" uniqKey="Kulshreshtha A" first="Amit" last="Kulshreshtha">Amit Kulshreshtha</name><affiliation><nlm:aff id="aff2">Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India</nlm:aff></affiliation></author><author><name sortKey="Kalra, Poonam" sort="Kalra, Poonam" uniqKey="Kalra P" first="Poonam" last="Kalra">Poonam Kalra</name><affiliation><nlm:aff id="aff2">Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India</nlm:aff></affiliation></author><author><name sortKey="Sharma, Meenakshi" sort="Sharma, Meenakshi" uniqKey="Sharma M" first="Meenakshi" last="Sharma">Meenakshi Sharma</name><affiliation><nlm:aff id="aff2">Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22345978</idno><idno type="pmc">3275963</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3275963</idno><idno type="RBID">PMC:3275963</idno><idno type="doi">10.4103/0970-9185.92480</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002007</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002007</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Anesthetic management of a 137-year-old patient fracture of neck femur</title><author><name sortKey="Nanda, Samridhi" sort="Nanda, Samridhi" uniqKey="Nanda S" first="Samridhi" last="Nanda">Samridhi Nanda</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia, Pt. Madan Mohan Malviya Hospital, New Delhi, India</nlm:aff></affiliation></author><author><name sortKey="Gupta, Anju" sort="Gupta, Anju" uniqKey="Gupta A" first="Anju" last="Gupta">Anju Gupta</name><affiliation><nlm:aff id="aff1">Department of Anaesthesia, Pt. Madan Mohan Malviya Hospital, New Delhi, India</nlm:aff></affiliation></author><author><name sortKey="Kulshreshtha, Amit" sort="Kulshreshtha, Amit" uniqKey="Kulshreshtha A" first="Amit" last="Kulshreshtha">Amit Kulshreshtha</name><affiliation><nlm:aff id="aff2">Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India</nlm:aff></affiliation></author><author><name sortKey="Kalra, Poonam" sort="Kalra, Poonam" uniqKey="Kalra P" first="Poonam" last="Kalra">Poonam Kalra</name><affiliation><nlm:aff id="aff2">Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India</nlm:aff></affiliation></author><author><name sortKey="Sharma, Meenakshi" sort="Sharma, Meenakshi" uniqKey="Sharma M" first="Meenakshi" last="Sharma">Meenakshi Sharma</name><affiliation><nlm:aff id="aff2">Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Anaesthesiology, Clinical Pharmacology</title><idno type="ISSN">0970-9185</idno><idno type="eISSN">2231-2730</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Priebe, Hj" uniqKey="Priebe H">HJ Priebe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pedersen, T" uniqKey="Pedersen T">T Pedersen</name></author><author><name sortKey="Eliasen, K" uniqKey="Eliasen K">K Eliasen</name></author><author><name sortKey="Henriksen, E" uniqKey="Henriksen E">E Henriksen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Glantz, L" uniqKey="Glantz L">L Glantz</name></author><author><name sortKey="Drenger, B" uniqKey="Drenger B">B Drenger</name></author><author><name sortKey="Gozal, Y" uniqKey="Gozal Y">Y Gozal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rodgers, A" uniqKey="Rodgers A">A Rodgers</name></author><author><name sortKey="Walker, N" uniqKey="Walker N">N Walker</name></author><author><name sortKey="Schug, S" uniqKey="Schug S">S Schug</name></author><author><name sortKey="Mckee, A" uniqKey="Mckee A">A McKee</name></author><author><name sortKey="Kehlet, H" uniqKey="Kehlet H">H Kehlet</name></author><author><name sortKey="Van Zundert, A" uniqKey="Van Zundert A">A van Zundert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dauphin, A" uniqKey="Dauphin A">A Dauphin</name></author><author><name sortKey="Raymer, Ke" uniqKey="Raymer K">KE Raymer</name></author><author><name sortKey="Stanton, Eb" uniqKey="Stanton E">EB Stanton</name></author><author><name sortKey="Fuller, Hd" uniqKey="Fuller H">HD Fuller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Inge, Ww" uniqKey="Inge W">WW Inge</name></author><author><name sortKey="Lineberger, Gc" uniqKey="Lineberger G">GC Lineberger</name></author><author><name sortKey="Lubarsky, Da" uniqKey="Lubarsky D">DA Lubarsky</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Anaesthesiol Clin Pharmacol</journal-id><journal-id journal-id-type="publisher-id">JOACP</journal-id><journal-title-group><journal-title>Journal of Anaesthesiology, Clinical Pharmacology</journal-title></journal-title-group><issn pub-type="ppub">0970-9185</issn><issn pub-type="epub">2231-2730</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22345978</article-id><article-id pub-id-type="pmc">3275963</article-id><article-id pub-id-type="publisher-id">JOACP-28-143</article-id><article-id pub-id-type="doi">10.4103/0970-9185.92480</article-id><article-categories><subj-group subj-group-type="heading"><subject>Letters to the Editor</subject></subj-group></article-categories><title-group><article-title>Anesthetic management of a 137-year-old patient fracture of neck femur</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Nanda</surname><given-names>Samridhi</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Gupta</surname><given-names>Anju</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Kulshreshtha</surname><given-names>Amit</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Kalra</surname><given-names>Poonam</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib><contrib contrib-type="author"><name><surname>Sharma</surname><given-names>Meenakshi</given-names></name><xref ref-type="aff" rid="aff2">1</xref></contrib></contrib-group><aff id="aff1">Department of Anaesthesia, Pt. Madan Mohan Malviya Hospital, New Delhi, India</aff><aff id="aff2"><label>1</label>Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India</aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Anju Gupta, Department of Anaesthesia, Pandit Madan Mohan Malviya Hospital, New Delhi, 438, pocket A, Sarita Vihar, New Delhi – 110 076, India. E-mail: <email xlink:href="dranjugupta2009@rediffmail.com">dranjugupta2009@rediffmail.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jan-Mar</season><year>2012</year></pub-date><volume>28</volume><issue>1</issue><fpage>143</fpage><lpage>144</lpage><permissions><copyright-statement>Copyright: © Journal of Anaesthesiology Clinical Pharmacology</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions></article-meta></front><body><p>Sir,</p><p>Management of geriatric patients can be a challenge to anesthesiologist due to limited organ reserve, the compromised organ function, and the unique disease predispositions.[<xref ref-type="bibr" rid="ref1">1</xref>] A 137-year-old man came with fracture neck femur for dynamic hip screw surgery (DHS). Patient had dementia and was a known case of ischemic heart disease (IHD)since 8 years. He was therapy with oral ramipril 2.5 mg once a day (OD), monotrate 10 mg twice a day, atorvastatin 10 mg OD, and aspirin 75 mg OD. He also had presbyopia, lens opacification, decreased high-frequency acuity, was edentulous, decreased muscle mass, and decreased bone density. His general condition was poor (wt: 45 kg, body mass index: 17.58 kg/m<sup>2</sup>) with pulse 94 beats per minute regular and blood pressure 110/70 mm Hg. Systemic examination was otherwise normal. Biochemical evaluation showed hemoglobin of 9.9 g/dl, blood sugar (random) 160 mg/dl, normal liver function test, and serum creatinine of 1.3 mg/dl. Chest X-ray showed emphysematous changes and pulmonary function tests were suggestive of mild restrictive and obstructive changes.</p><p>Electrocardiogram had changes suggestive of an old inferior wall myocardial infarction. Echocardiography revealed left ventricular (LV) anterolateral hypokinesia and LV diastolic/systolic dysfunction with LV ejection fraction 35–40%. Dobutamine stress echocardiography was negative for ischemia. The patient was started on enoxaparin 40 mg subcutaneous OD, which was continued in the postoperative period.</p><p>It was decided to give continuous epidural anesthesia with routine monitoring (five lead ECG, noninvasive blood pressure, pulse oximetry, and temperature). A central venous catheter was inserted in the right internal jugular vein to guide fluid management. A 20G Epidural catheter space was placed by paramedian approach via the L3-L4 interspace and it was fixed at 8 cm (12 h after dose of enoxaparin). Test dose of 3 ml 2% lidocaine, with 1:200,000 epinephrine, was injected. A total of 10 ml 0.5% bupivacaine with 2 mcg/ml fentanyl was given in a titrated manner through catheter, to achieve a sensory level of T8. Oxygen was administered by the mask @ 6 l/min and fluids were given to maintain a central venous pressure of 8–10 mm Hg. The patient remained hemodynamically stable throughout the 90 min procedure. After the surgery, patient was shifted to the intensive care unit for monitoring. Postoperative analgesia was given by an epidural infusion of 0.125% bupivacaine with fentanyl 2 mcg/ml @ 2–4 ml/h. Effective postoperative pain relief led to patient ambulation on 3<sup>rd</sup> post-op day in this case, decreasing the risk of embolism and stroke.</p><p>Perioperative adverse effects on the cardiac, pulmonary, cerebral systems, and on cognitive function are the main concerns for elderly surgical patients.[<xref ref-type="bibr" rid="ref2">2</xref>] Regional anesthesia techniques attenuate the perioperative stress response, improve myocardial oxygenation, reduce the release of troponin T, and effectively control refractory unstable angina pectoris.[<xref ref-type="bibr" rid="ref3">3</xref>] A recent systemic review on 141 trials including 9559 patients reported that overall mortality and the number of myocardial infarction were reduced by one-third in patients who were allocated to neuraxial block.[<xref ref-type="bibr" rid="ref4">4</xref>] Epidural anesthesia also decreases blood loss during total hip arthroplasty, prevents intraoperative hypertension in patients with intraoperative ischemia, maintains tissue perfusion, and reduces postoperative pulmonary complications and reduced cognitive dysfunction.[<xref ref-type="bibr" rid="ref2">2</xref><xref ref-type="bibr" rid="ref4">4</xref><xref ref-type="bibr" rid="ref5">5</xref>] These advantages strongly support the use of regional anesthesia for elderly patients undergoing surgery.[<xref ref-type="bibr" rid="ref3">3</xref><xref ref-type="bibr" rid="ref4">4</xref><xref ref-type="bibr" rid="ref6">6</xref>]</p><p>We successfully managed the oldest patient receiving anaesthesia for surgery (as per Limca Book of records) for DHS under epidural anesthesia with bupivacaine and fentanyl. Considering the age, poor cardiorespiratory function, epidural anesthesia was considered the anesthetic technique of choice in the present case.</p></body><back><ref-list><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Priebe</surname><given-names>HJ</given-names></name></person-group><article-title>The aged cardiovascular risk patient</article-title><source>Br J Anaesth</source><year>2000</year><volume>85</volume><fpage>763</fpage><lpage>78</lpage><pub-id pub-id-type="pmid">11094595</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pedersen</surname><given-names>T</given-names></name><name><surname>Eliasen</surname><given-names>K</given-names></name><name><surname>Henriksen</surname><given-names>E</given-names></name></person-group><article-title>A prospective study of mortality associated with anaesthesia and surgery: Risk indicators of mortality in hospital</article-title><source>Acta Anaesthesiol Scand</source><year>1990</year><volume>34</volume><fpage>176</fpage><lpage>82</lpage><pub-id pub-id-type="pmid">2343717</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Glantz</surname><given-names>L</given-names></name><name><surname>Drenger</surname><given-names>B</given-names></name><name><surname>Gozal</surname><given-names>Y</given-names></name></person-group><article-title>Perioperative myocardial ischemia in cataract surgery patients: General versus local anesthesia</article-title><source>Anesth Analg</source><year>2000</year><volume>91</volume><fpage>1415</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">11093991</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rodgers</surname><given-names>A</given-names></name><name><surname>Walker</surname><given-names>N</given-names></name><name><surname>Schug</surname><given-names>S</given-names></name><name><surname>McKee</surname><given-names>A</given-names></name><name><surname>Kehlet</surname><given-names>H</given-names></name><name><surname>van Zundert</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Results from overview of randomised trials</article-title><source>BMJ</source><year>2000</year><volume>321</volume><fpage>1493</fpage><pub-id pub-id-type="pmid">11118174</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dauphin</surname><given-names>A</given-names></name><name><surname>Raymer</surname><given-names>KE</given-names></name><name><surname>Stanton</surname><given-names>EB</given-names></name><name><surname>Fuller</surname><given-names>HD</given-names></name></person-group><article-title>Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: Effects of epidural block on hip arthroplasty</article-title><source>J Clin Anesth</source><year>1997</year><volume>9</volume><fpage>200</fpage><lpage>3</lpage><pub-id pub-id-type="pmid">9172026</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Inge</surname><given-names>WW</given-names></name><name><surname>Lineberger</surname><given-names>GC</given-names></name><name><surname>Lubarsky</surname><given-names>DA</given-names></name></person-group><person-group person-group-type="editor"><name><surname>McLeskey</surname><given-names>CH</given-names></name></person-group><article-title>Major vascular procedures</article-title><source>Geriatric Anesthesiology</source><year>1997</year><publisher-loc>Philadelphia</publisher-loc><publisher-name>Williams and Wilkins</publisher-name><fpage>637</fpage><lpage>44</lpage></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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