Spinal Nerve Block and Recovery after Spinal Anesthesia in Frail Patients - a Prospective Cohort Study

Abstract BackgroundFrailty in surgical patients is associated with significantly higher incidences of perioperative mortality and complications. Although neuraxial anesthesia is preferable alternative to general anesthesia in frail patients, it remains undetermined whether the pharmacodynamic profiles of local anesthetics used in intrathecal spinal nerve blocks are altered in this population.MethodsThis prospective observational cohort study recruited 62 patients scheduled for operations that were able to be performed under spinal anesthesia between April 22 to June 30, 2020 in our hospitals. Levels of dermatome blockage after spinal anesthesia and the recovery of spinal nerve sensory and motor function were recorded.ResultsThe prevalence of frailty in patients receiving spinal anesthesia in this study was 25.8%. Compared with non-frail patients, frail patients were significantly older, had a higher proportion of females, and tolerated less intense metabolic equivalent activities. The pre-surgical incision sensory blockage levels were not different between frail and non-frail patients following intrathecal administration of similar dose of bupivacaine. Time intervals to pain sensation at surgical sites (sensory recovery) and voluntary knee flexion (motor recovery) were also similar between the frail and non-frail groups. But, frail patients were associated with more episodes of hypotension and required more vasopressors during operations.ConclusionOur study illustrates that bupivacaine sensitivity in spinal nerve blocks is not significantly affected by frailty. However, special attention should be paid to correct intraoperative hypotension after spinal anesthesia in frail patients.

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COVID-19 hospital outbreaks: Protecting healthcare workers to protect frail patients. An Italian observational cohort study

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2020.10.098 ◽

2021 ◽

Vol 102 ◽

pp. 532-537

Author(s):

Luigi Vimercati ◽

Luigi De Maria ◽

Marco Quarato ◽

Antonio Caputi ◽

Pasquale Stefanizzi ◽

...

Keyword(s):

Cohort Study ◽

Healthcare Workers ◽

Observational Cohort Study ◽

Frail Patients ◽

Observational Cohort

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Spinal Anesthesia for Patients With Coronavirus Disease 2019 and Possible Transmission Rates in Anesthetists: Retrospective, Single-centre, Observational Cohort Study

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000732456.44839.84 ◽

2021 ◽

Vol 41 (1) ◽

pp. 28-29

Author(s):

Q. Zhong ◽

Y.Y. Liu ◽

Q. Lou ◽

Y.F. Zou ◽

H.X. Jiang ◽

...

Keyword(s):

Cohort Study ◽

Spinal Anesthesia ◽

Observational Cohort Study ◽

Single Centre ◽

Transmission Rates ◽

Observational Cohort

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Perioperative noninvasive cardiac output monitoring in parturients with singleton and twin pregnancies undergoing cesarean section under spinal anesthesia with prophylactic phenylephrine drip: a prospective observational cohort study

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2018.1480604 ◽

2018 ◽

Vol 32 (23) ◽

pp. 3980-3985 ◽

Cited By ~ 1

Author(s):

S. Orbach-Zinger ◽

E. Razinsky ◽

I. Bizman ◽

S. Firman ◽

R. Gat ◽

...

Keyword(s):

Cardiac Output ◽

Cohort Study ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Observational Cohort Study ◽

Cardiac Output Monitoring ◽

Prospective Observational Cohort Study ◽

Observational Cohort ◽

Output Monitoring ◽

Twin Pregnancies

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Effectiveness of meperidine versus tramadol on post spinal anesthesia shivering in elective cesarean section: A prospective observational cohort study

International Journal of Surgery Open ◽

10.1016/j.ijso.2020.11.005 ◽

2021 ◽

Vol 28 ◽

pp. 22-26

Author(s):

Abere Tilahun ◽

Ashenafi Seifu ◽

Adugna Aregawi ◽

Bacha Abera ◽

DesalegnGetnet Demsie

Keyword(s):

Cohort Study ◽

Cesarean Section ◽

Spinal Anesthesia ◽

Observational Cohort Study ◽

Elective Cesarean Section ◽

Prospective Observational Cohort Study ◽

Elective Cesarean ◽

Observational Cohort

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The FRAIL-FIT 30 Study – Factors influencing 30-day mortality in frail patients admitted to ICU: A retrospective observational cohort study

Journal of the Intensive Care Society ◽

10.1177/1751143720985164 ◽

2021 ◽

pp. 175114372098516

Author(s):

David Hewitt ◽

Michael Ratcliffe ◽

Malcolm G Booth

Keyword(s):

Cohort Study ◽

Single Point ◽

Observational Cohort Study ◽

Adverse Outcomes ◽

Royal Infirmary ◽

Clinical Frailty Scale ◽

Icu Admission ◽

Frail Patients ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

Background Frailty is a multi-dimensional syndrome of reduced reserve, resulting from overlapping physiological decrements across multiple systems. The contributing factors, temporality and magnitude of frailty’s effect on mortality after ICU admission are unclear. This study assessed frailty’s impact on mortality and life sustaining therapy (LST) use, following ICU admission. Methods This single-centre retrospective observational cohort study analysed data collected prospectively in Glasgow Royal Infirmary ICU. Of 684 eligible patients, 171 were frail and 513 were non-frail. Frailty was quantified using the Rockwood Clinical Frailty Scale (CFS). All patients were followed up 1-year after ICU admission. The primary outcome was all-cause mortality at 30-days post-ICU admission. Key secondary outcomes included mortality at 1-year and LST use. Results Frail patients were significantly less likely to survive 30-days post-ICU admission (61.4% vs 81.1%, p < 0.001). This continued to 1-year (48.5% vs 68.2%, p < 0.001). Frailty significantly increased mortality hazards in covariate-adjusted analyses at 30-days (HR 1.56; 95%CI 1.14–2.15; p = 0.006), and 1-year (HR 1.35; 95%CI 1.03–1.76; p = 0.028). Single-point CFS increases were associated with a 30-day mortality hazard of 1.23 (95%CI 1.13–1.34; p < 0.001) in unadjusted analyses, and 1.11 (95%CI 1.01–1.22; p = 0.026) after covariate adjustment. Frail patients received significantly more days of LST (median[IQR]: 5[3,11] vs 4[2,9], p = 0.008). Conclusion Frailty was significantly associated with greater mortality at all time points studied, but most notably in the first 30-days post-ICU admission. This was despite greater LST use. The accrual effect of frailty increased adverse outcomes. Point-by-point use of frailty scoring could allow for more informed decision making in ICU.

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The FRAIL-FIT study: Frailty’s relationship with adverse-event incidence in the longer term, at one year following intensive care unit treatment – A retrospective observational cohort study

Journal of the Intensive Care Society ◽

10.1177/1751143719838212 ◽

2019 ◽

Vol 21 (2) ◽

pp. 124-133 ◽

Cited By ~ 1

Author(s):

David Hewitt ◽

Malcolm G Booth

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Confidence Interval ◽

Observational Cohort Study ◽

Clinical Frailty Scale ◽

Frail Patients ◽

Observational Cohort ◽

One Year ◽

Retrospective Observational Cohort Study

Introduction Frailty is a syndrome of decreased reserve and heightened vulnerability. Frailty scoring has potential to facilitate more informed decisions in the intensive care unit. To validate this, its relationship with outcomes must be tested extensively. This study aimed to investigate frailty’s impact on adverse outcomes after intensive care unit admission, primarily one-year mortality. Methods This single-centre retrospective observational cohort study examined prospectively collected data from 400 intensive care unit patients. Frailty was assessed using the Clinical Frailty Scale and defined as Clinical Frailty Scale ≥ 5. Unadjusted and adjusted analyses tested the relationships of frailty, covariates and outcomes. Results Of 400 eligible patients, 111 (27.8%) were frail and 289 (72.3%) were non-frail. Compared to non-frail patients, frail patients were older (62 vs. 56, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation II scores (22 vs. 19, p < 0.001). Females were more likely to be frail than males (34.1% vs. 22.9% frail, p = 0.018). Frail patients were less likely to survive the intensive care unit (p = 0.03), hospital (p = 0.003) or to one year (p < 0.001). Frailty significantly increased one-year mortality hazards in unadjusted analyses (hazard ratio 1.96; 95% confidence interval 1.41–2.72; p < 0.001) and covariate adjusted analyses (hazard ratio 1.41; 95% confidence interval 1.00–1.98; p = 0.0497). Frail patients had more hospital admissions (p = 0.014) and longer hospital stays within both one year before (p = 0.002) and one year after intensive care unit admission (p = 0.012). Conclusions Frailty was common and associated with greater age, female gender, higher sickness severity and more healthcare use. Frailty was significantly associated with greater risks of mortality in both unadjusted and adjusted analyses. Frailty scoring is a promising tool which could improve decision making in intensive care.

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