Yasuhiro Watanabe*, Kayoko Matsunuma, Kaoru Watanabe, Hazuki Okawa, Mitsumasa Miyagi and Toru Kaneda
Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, JapanFulltext PDF
The number of elderly patients undergoing orthopedic surgery is continuously increasing in Japan. Very elderly patients have limited cardiopulmonary reserve, and complications may induce intraoperative hemodynamic compromise, particularly in an emergency setting. This retrospective study investigated the hemodynamic characteristics of very elderly patients undergoing either emergency or elective orthopedic surgery using preoperative Transthoracic Echocardiography (TTE). We enrolled 125 patients and compared the following TTE parameters between 64 elective and 61 emergency patients using the 2-D Teichholz method: end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, and fractional shortening. Patients undergoing emergency surgery had a significantly lower stroke volume and stroke index, but a significantly higher heart rate than elective patients. The ejection fraction and fractional shortening were not significantly different, and the cardiac index was almost identical between the two groups. Our results suggest that elderly patients undergoing emergency orthopedic surgery are volume-depleted, and their cardiac output is maintained primarily by compensatory activation of the sympathetic nervous system. Preoperative non-invasive TTE examination was capable of evaluating the hemodynamic status of elderly patients undergoing emergency orthopedic surgery. Both general and regional anesthesia may induce cardiovascular instability to varying degrees. Anesthesiologists should respect the importance of preoperative fluid administration and meticulously monitor and manage these patients perioperatively.
Elderly; Emergency treatment; Hip fractures; Preoperative care; Transthoracic echocardiography
Watanabe Y, Matsunuma K, Watanabe K, Okawa H, Miyagi M, Kaneda T. Analysis of Preoperative Transthoracic Echocardiographic Parameters in Elderly Patients Undergoing Emergency Orthopedic Surgery. Clin Surg. 2019; 4: 2683..