Effect of electroencephalography-guided anesthesia on neurocognitive disorders in elderly patients undergoing major non-cardiac surgery: A trial protocol The POEGEA trial (POncd Elderly GEneral Anesthesia)

Introduction The number of elderly patients undergoing major surgery is rapidly increasing. They are particularly at risk of developing postoperative neurocognitive disorders (NCD). Earlier studies suggested that processed electroencephalographic (EEG) monitors may reduce the incidence of postoperative NCD. However, none of these studies controlled for intraoperative nociception levels or personalized blood pressure targets. Their results remain unclear if the reduction in the incidence of postoperative NCD relates to avoidance of any electroencephalographic pattern suggesting excessive anesthesia depth. Objective The objective of this trial is to investigate–in patients ≥ 70 years old undergoing major non-cardiac surgery–the effect of EEG-guided anesthesia on postoperative NCD while controlling for intraoperative nociception, personalized blood pressure targets, and using detailed information provided by the EEG monitor (including burst suppression ratio, density spectral array, and raw EEG waveform). Material and methods This prospective, randomized, controlled trial will be conducted in a single Canadian university hospital. Patients ≥ 70 years old undergoing elective major non-cardiac surgery will be included in the trial. The administration of sevoflurane will be adjusted to maintain a BIS index value between 40 and 60, to keep a Suppression Ratio (SR) at 0%, to keep a direct EEG display without any suppression time and a spectrogram with most of the EEG wave frequency within the alpha, theta, and delta frequencies in the EEG-guided group. In the control group, sevoflurane will be administered to achieve an age-adjusted minimum alveolar concentration of [0.8–1.2]. In both groups, a nociception monitor will guide intraoperative opioid administration, individual blood pressure targets will be used, and cerebral oximetry used to tailor intraoperative hemodynamic management. The primary endpoint will be the incidence of NCD at postoperative day 1, as evaluated by the Montreal Cognitive Assessment (MoCA). Secondary endpoints will include the incidence of postoperative NCD at different time points and the evaluation of cognitive trajectories up to 90 days after surgery among EEG-guided and control groups. Study registration NCT04825847 on ClinicalTrials.gov.

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Therapeutic effect of nifedipine combined with enalapril on elderly patients with coronary heart disease complicated with hypertension

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v2i6.671 ◽

2018 ◽

Vol 2 (6) ◽

Author(s):

Xiaoye Wang

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

Elderly Patients ◽

Adverse Reactions ◽

Effective Rate ◽

Control Group ◽

Significant Difference ◽

Pre Treatment ◽

Experimental Group

ã€Abstractã€‘Objective: Toanalyze the efficacy of combined drug therapy for elderly patients with coronary heart disease and hypertension.METHODS:Sixty-six elderly patients with coronary heart disease and hypertension were enrolled from December 2017 to November 2018. They were randomly divided into two groups, 33 patients in each group. Patients in the experimental group received nifedipine. In combination with enalapril, patients enrolled in the control group received nifedipine monotherapy.RESULTS:Compared with the control group, the total effective rate, Serum Nitric Oxide (Serum NO) after treatment, CRP after treatment, HCY after treatment, and blood pressure after treatment were significantly improved (P<0.05). Serum NO and treatment before treatment in the 2 groups. There was no significant difference in pre-CRP, pre-treatment HCY, pre-treatment blood pressure, and adverse reactions during treatment (P>0.05).Conclusion: Theelderly patients with coronary heart disease and hypertension are treated with nifedipine and enalapril.

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SURGICAL TREATMENT OF ATRIAL FIBRILLATION IN ELDERLY PATIENTS UNDERGOING HIGH RISK CARDIAC SURGERY

10.22541/au.162214407.72009074/v1 ◽

2021 ◽

Author(s):

Mohsin Uzzaman ◽

Imthiaz Manoly ◽

Mohini Panikkar ◽

Maciej Matuszewski ◽

Nicolas Nikolaidis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Surgical Treatment ◽

High Risk ◽

Elderly Patients ◽

Control Group ◽

Surgical Ablation ◽

Af Ablation

BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

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Experience with the Preoperative Invasive Measurement of Haemodynamic, Respiratory and Renal Function in 100 Elderly Patients Scheduled for Major Abdominal Surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x8801600402 ◽

1988 ◽

Vol 16 (4) ◽

pp. 389-395 ◽

Cited By ~ 80

Author(s):

P. Older ◽

R. Smith

Keyword(s):

Blood Pressure ◽

Intensive Care Unit ◽

Renal Function ◽

Intensive Care ◽

Cardiac Index ◽

Elderly Patients ◽

Major Surgery ◽

Intrapulmonary Shunt ◽

The Mean ◽

Invasive Measurement

The extent of physiological disturbance in a preoperative population of 100 elderly patients scheduled for elective major surgery was measured. Haemodynamic, respiratory and renal function were evaluated preoperatively in the intensive care unit. Of these patients 13% had serious problems requiring either postponement of the operation (7%) or its cancellation (6%). Cardiac index was 2.2 l/min/m2 or less in 11% of patients; creatinine clearance 50 ml/min or less in 19% of patients; mean blood pressure was equal to or exceeded 120 mmHg in 15% of patients and intrapulmonary shunt equalled or exceeded 15% in 10% of patients. The mean duration of stay in the intensive care unit was four days, including the preoperative day. The logistics of preoperative admission were implemented without undue difficulty.

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High positive end expiratory pressure levels affect hemodynamics in elderly patients with hypertension admitted to the intensive care unit: a prospective cohort study

BMC Pulmonary Medicine ◽

10.1186/s12890-019-0965-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Lili Zhou ◽

Guoen Cai ◽

Zhihui Xu ◽

Qinyong Weng ◽

Qinyong Ye ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Elderly Patients ◽

Airway Pressure ◽

Heart Function ◽

Venous Pressure ◽

Trial Registration ◽

Control Group ◽

Positive End Expiratory Pressure ◽

Central Venous

Abstract Background To study the effects of different positive end expiratory pressure (PEEP) on blood pressure and heart function in elderly patients with hypertension. Methods Forty elderly patients above 65 years of age treated with mechanical ventilation were divided into two groups: a control group of non-hypertensive subjects (n = 18) and a hypertension group (n = 22) patients with essential hypertension. Changes in blood pressure, central venous pressure (CVP), central venous oxygen saturation (ScvO2), heart rate, and airway pressure were determined in response to different selected PEEP levels of 0, 2, 4, 6, 8, 10 and 12 cm H2O under SIMV(PC) + PSV mode throughout the study. Results In both groups, the increase in PEEP led to an increase in CVP and airway pressure. When PEEP was above 4 cm H2O in the hypertension group, a decrease in blood pressure and ScvO2, and an increase of heart rate were observed. These results indicated that cardiac output significantly decreased. Conclusion High levels of PEEP can significantly influence changes in blood pressure and heart function in elderly patients with hypertension. Trial registration This trial was retrospectively registered, The Chinese trial registration number is ChiCTR-ROC-17012873. The date of registration is 10-2-2017.

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Outcome Improvement and Cost Reduction in an Increasingly Morbid Cardiac Surgery Population

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253206289009 ◽

2006 ◽

Vol 10 (2) ◽

pp. 171-175 ◽

Cited By ~ 13

Author(s):

Scott M. Goldman ◽

Francis P. Sutter ◽

Mary Ann C. Wertan ◽

Francis D. Ferdinand ◽

Candace L. Trace ◽

...

Keyword(s):

Cardiac Surgery ◽

Artery Bypass ◽

Clinical Effectiveness ◽

Cerebral Oximetry ◽

Control Group ◽

Study Group ◽

Bypass Grafting ◽

Off Pump ◽

Prolonged Ventilation ◽

Pump Coronary Artery Bypass

Two studies assessed initiatives to improve the quality and the cost-effectiveness of cardiac surgery. The first evaluated a system for access and stabilization (SAS), with coronary stabilization, and a clinical effectiveness quality initiative (CEQI) in off-pump coronary artery bypass grafting. The SAS + CEQI cohort showed significantly lower mortality, a lower percentage of patients requiring prolonged ventilation, and a shorter mean postoperative length of hospital stay than the pre-SAS cohort who underwent on-pump coronary artery bypass grafting. The second study assessed the potential for noninvasive cerebral oximetry to reduce strokes related to all cardiac surgery by optimizing cerebral oxygen delivery. The incidence of permanent stroke was significantly lower in the cerebral oximetry group than in an earlier control group in which cerebral oximetry was not used, despite the fact that the study group had a significantly greater number of patients in New York Heart Association classes III and IV. The proportion of patients requiring prolonged ventilation was significantly lower, and the length of postoperative hospital stay was significantly shorter in the study group than in the control group. The incidence of cerebrovascular accident in the study group was 0.97%, compared with 2.03% in the controls. This translated to a potential avoidance of 12 cerebrovascular accidents and approximately $254 214 in direct costs and more than $425000 in total costs. The results show that specific measures can improve outcomes and reduce costs in cardiac surgery. Therefore, the use of a clinical effectiveness quality initiative and cerebral oximetry in all cardiac surgery, with the SAS system for off-pump surgery, should be advocated.

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CLONIDINE AS AN ADJUVANT TO HYPERBARIC BUPIVACAINE FOR SPINAL ANESTHESIA IN ELDERLY PATIENTS UNDERGOING INFRAUMBLICAL SURGERIES

10.36106/ijsr/3217567 ◽

2021 ◽

pp. 72-74

Author(s):

Purushottam Singhal ◽

Suresh Pandey ◽

. S. P. Chittora

Keyword(s):

Blood Pressure ◽

Elderly Patients ◽

Systolic Blood Pressure ◽

Spinal Anesthesia ◽

Sensory Block ◽

Primary Study ◽

Control Group ◽

Sensory Level ◽

Hyperbaric Bupivacaine ◽

Small Doses

Background: Use of adjuvant with small doses of local anesthetics is a preferred technique for spinal anesthesia for lower limb surgeries. This study tested the hypothesis that addition of small doses of clonidine augments the spinal block levels produced by hyperbaric bupivacaine in patients without affecting the side-effects. Materials and Methods: This was a prospective, randomized, double-blind study. Above 60 years patients were allocated to three equal groups. Group C received 10 mg hyperbaric bupivacaine without clonidine while Group C and Group C received 15 μg and 30 μg clonidine with 15 30 hyperbaric bupivacaine respectively for spinal anesthesia. Effect of clonidine on sensory block levels was the primary study outcome measure. Motor blockade and hemodynamic parameters were also studied. Results:Asignicantly higher median block levels were achieved in Group C (P < 0.05) and Group C (P <0.05) than Group C. Highest median 15 30 sensory block level, the mean times for sensory regression to T12 level and motor block regression were statistically signicant between Groups C15 and C and between Groups C and C. On comparison of fall in systolic blood pressure trends, there was no signicant difference in the clonidine 30 groups as compared with the control group. Conclusions: In elderly patients, clonidine when used intrathecally in doses of 15 μg or 30 μg with bupivacaine, signicantly potentiated the sensory block levels and duration of analgesia without affecting the trend of systolic blood pressure as compared to bupivacaine alone. Clonidine in doses of 30 μg however facilitated the ascent of sensory level block to unexpectedly higher dermatomes for a longer time.

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The Evolution of Cardiovascular Surgery in Elderly Patient: A Review of Current Options and Outcomes

BioMed Research International ◽

10.1155/2014/736298 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 29

Author(s):

Francesco Nicolini ◽

Andrea Agostinelli ◽

Antonella Vezzani ◽

Tullio Manca ◽

Filippo Benassi ◽

...

Keyword(s):

Cardiac Surgery ◽

Elderly Patients ◽

Artery Bypass ◽

Cardiac Surgical Procedures ◽

Mitral Valve Surgery ◽

Clinical State ◽

Major Surgery ◽

Average Life Expectancy ◽

Satisfactory Outcome ◽

Surgery In Elderly

Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient.

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Hemodilution in High Risk Cardiac Surgery: Laboratory Values, Physiological Parameters and Outcomes

10.1101/2021.07.14.21260529 ◽

2021 ◽

Author(s):

Domagoj Mladinov ◽

Luz A Padilla ◽

Benjamin Leahy ◽

Joseph B Norman ◽

Jacob Enslin ◽

...

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Bypass Graft ◽

Physiological Parameters ◽

Cerebral Oximetry ◽

Organ Injury ◽

Conservation Strategy ◽

Control Group ◽

Blood Conservation ◽

Allogenic Blood

Background: Acute normovolemic hemodilution (ANH) is a blood conservation strategy in cardiac surgery, predominantly used in coronary artery bypass graft (CABG) and/or valve procedures. Although higher complexity cardiac procedures may benefit from ANH, concerns for hemodynamic instability and organ injury during hemodilution hinder its wider acceptance. Laboratory and physiological parameters during hemodilution in complex cardiac surgeries have not been described. Study Design and Methods: This observational cohort (2019-2021) study included 169 patients who underwent thoracic aortic repair, multiple valve procedure, concomitant CABG with the aforementioned procedure, and/or redo sternotomies. Patients who received allogeneic blood were excluded. Statistical comparisons were performed between ANH (N=66) and non ANH controls (N=103). ANH consisted of removal of blood at the beginning of surgery and its return after cardiopulmonary bypass (CPB). Results: Intraoperatively, the ANH group received more albumin (p=0.04) and vasopressor medications (p=0.01); while urine output was no different between ANH and controls. Bilateral cerebral oximetry (rSO2) values were similar before and after hemodilution. During bypass rSO2 were discretely lower in the ANH vs. control group (right rSO2 p=0.03, left rSO2 (p=0.05). No differences in lactic acid values were detected across the procedural continuum. Postoperatively, no differences in extubation times, ICU length of stay, kidney injury, stroke or infection were demonstrated. Discussion: This study suggests hemodilution to be a safe and comparable blood conservation technique, even without accounting for potential benefits of reduced allogenic blood administration. The study may contribute to better understanding and wider acceptance of ANH protocols in high risk cardiac surgeries.

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Tera Gymnastic Effective For Patient With Hypertension

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v7i3.991 ◽

2019 ◽

Vol 7 (3) ◽

Author(s):

Hesti Platini ◽

Sandra Pebrianti ◽

Indra Maulana

Keyword(s):

Physical Activity ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Intervention Group ◽

Management Plan ◽

Control Group ◽

Body Parts ◽

Blood Pressure Targets ◽

Significant Difference ◽

Before And After

Hypertension is a cardiovascular disease globally. Hypertension is remains silent killer, the clinical strategy to focusing on new and improved treatments is exercise. Tera gymnastics is a physical and mental exercise, combining the movement of body parts with breathing techniques and rhythms through the concentration of thought that is carried out regularly, harmoniously, correctly and continuously, Physical activity can reduce high blood pressure. Some study showed Regular physical activity is an effective intervention with respect to these factor, decreasing mortality rate for cardiovascular disease and all cause of disease in hypertensive patient. Gymnastic Tera exercise can help to control metabolic variable related to hypertension. The study was use quasy experimental design with one group pretest-posttest. The study was conducted in Puskesmas Pasundan Garut. Sampling in this study is subjects that is criteria patients has hipertension with 8 weeks treatment so will take methode of concecutive sampling with 15 respondents for intervention group and 15 for control group. The sample were age 30-55 years. The Intervention was gymnastic tera exercise. The Blood pressure function was evaluated before and after the training period. The data were analyzed by using t-test paired. The result showed a significant difference before and after tera gymnastic exercise in patient with hypertension I (p=000.0). Result of systolic blood presure when in mean SD pretest is 146.00 higher than post test is 136.00 in intervention group. The tera gymnastic exercise conditioning program achieved effect in this population. The reduction of blood pressure after exercise is of great clinical relevance. The increased riskof physical inactivity in controlling hypertension in our study suggest that general practitioners must be in the habit of prescribing practice of physical exercise. Physical activity has been shown to have beneficial effect on blood pressure. patients are followed up regularly to confirm that they are adhering to the management plan and the blood pressure targets.

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