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Geriatric Anesthesia: Clinical Sciences

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Anesthesiology".

Deadline for manuscript submissions: closed (25 May 2023) | Viewed by 10871

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Dr. Yumiko Ishizawa

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Guest Editor

Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Gray Jackson 444, Boston, MA 02114, USA
Interests: general anesthesia; anesthetics inhalation; anesthetics intravenous; anesthesia mechanisms; unconsciousness; cognitive dysfunction; geriatric anesthesia; global warming

Special Issue Information

Dear Colleagues,

Currently, about one-third of surgical patients are 65 years and older. The population of older adults is rapidly growing worldwide and the population having surgery is aging at a faster rate than the general population. Overall morbidity and mortality are higher in elderly surgical patients for a variety of reasons. The anesthetic care of elderly patients is becoming an increasingly important aspect of perioperative medicine. In recent years, perioperative neurocognitive disorders, including postoperative delirium, in elderly surgical patients have been recognized for their medical and social impact as well as possible association with Alzheimer’s disease, but their prevention and treatment are not yet established. Frailty is another challenging entity in the elderly. This Special Issue of the Journal of Clinical Medicine will focus on the perioperative care of patients of advanced ages. In particular, it will discuss the strategies and approaches that are demonstrated to be effective in improving overall or specific outcomes, including neurocognitive functions, frailty, cardiovascular and other organ functions, surgical recovery, and pain. It will welcome all aspects of perioperative geriatric care, including presurgical optimization, anesthetic management and monitoring, and enhanced recovery after surgery.

Dr. Yumiko Ishizawa
Guest Editor

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Keywords

geriatric anesthesia
postoperative delirium
perioperative neurocognitive disorder
frailty
Alzheimer’s disease and related dementia
aging
normal aging

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Published Papers (4 papers)

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Research

14 pages, 1510 KiB

Open AccessArticle

Geriatric Surgery Produces a Hypoactive Molecular Phenotype in the Monocyte Immune Gene Transcriptome

by Rachel L. Oren, Rachel H. Grasfield, Matthew B. Friese, Lori B. Chibnik, John H. Chi, Michael W. Groff, James D. Kang, Zhongcong Xie, Deborah J. Culley and Gregory Crosby

J. Clin. Med. 2023, 12(19), 6271; https://doi.org/10.3390/jcm12196271 - 28 Sep 2023

Viewed by 1432

Abstract

Surgery is a major challenge for the immune system, but little is known about the immune response of geriatric patients to surgery. We therefore investigated the impact of surgery on the molecular signature of circulating CD14⁺ monocytes, cells implicated in clinical recovery from surgery, in older patients. We enrolled older patients having elective joint replacement (N = 19) or spine (N = 16) surgery and investigated pre- to postoperative expression changes in 784 immune-related genes in monocytes. Joint replacement altered the expression of 489 genes (adjusted p < 0.05), of which 38 had a |logFC| > 1. Spine surgery changed the expression of 209 genes (adjusted p < 0.05), of which 27 had a |logFC| > 1. In both, the majority of genes with a |logFC| > 1 change were downregulated. In the combined group (N = 35), 471 transcripts were differentially expressed (adjusted p < 0.05) after surgery; 29 had a |logFC| > 1 and 72% of these were downregulated. Notably, 21 transcripts were common across procedures. Thus, elective surgery in older patients produces myriad changes in the immune gene transcriptome of monocytes, with many suggesting development of an immunocompromised/hypoactive phenotype. Because monocytes are strongly implicated in the quality of surgical recovery, this signature provides insight into the cellular and molecular mechanisms of the immune response to surgery and warrants further study as a potential biomarker for predicting poor outcomes in older surgical patients. Full article

(This article belongs to the Special Issue Geriatric Anesthesia: Clinical Sciences)

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10 pages, 617 KiB

Open AccessArticle

The Neutrophil-to-Lymphocyte Ratio and Preoperative Pulmonary Function Test Results as Predictors of In-Hospital Postoperative Complications after Hip Fracture Surgery in Older Adults

by Seung-Wan Hong, Hae-Chang Jeong and Seong-Hyop Kim

J. Clin. Med. 2023, 12(1), 108; https://doi.org/10.3390/jcm12010108 - 23 Dec 2022

Cited by 7 | Viewed by 1849

Abstract

Purpose: This study retrospectively evaluated the usefulness of the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and pulmonary function test (PFT) results as objective predictors of in-hospital postoperative complications after hip fracture surgery in older adults. Methods: The patients aged >65 years who underwent hip fracture surgery under general anaesthesia were enrolled. In-hospital postoperative complications with preoperative NLR, PNI and PFT results were evaluated. The NLR was calculated as the preoperative neutrophil count/lymphocyte count in peripheral blood. The PNI was calculated as the serum albumin (g/dL) × 10 + total lymphocyte count × 0.005 (/mm³). Results: One hundred ninety nine patients were analysed. The most common postoperative complications were respiratory complications. Compared with patients who did not have postoperative complications, patients with postoperative complications had a significantly higher NLR (8.01 ± 4.70 vs. 5.12 ± 4.34, p < 0.001), whereas they had a significantly lower PNI (38.33 ± 6.80 vs. 42.67 ± 6.47, p < 0.001), preoperative functional vital capacity (FVC; 2.04 ± 0.76 vs. 2.45 ± 0.71 L, p < 0.001), and forced expiratory volume at 1 s (FEV1; 1.43 ± 0.53 vs. 1.78 ± 0.58 L, p < 0.001). Multiple logistic regression analysis identified NLR (odds ratio [OR], 1.142; 95% confidence interval [CI], 1.060–1.230; p < 0.001) and FEV1 (OR, 0.340; 95% CI, 0.191–0.603; p < 0.001) as risk factors for postoperative complications after hip fracture surgery. Conclusion: Preoperative NLR and FEV1 are objective predictors of in-hospital postoperative complications after hip fracture surgery in older patients. Full article

(This article belongs to the Special Issue Geriatric Anesthesia: Clinical Sciences)

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10 pages, 852 KiB

Open AccessArticle

Prevention of Bradycardia during Spinal Anesthesia under Dexmedetomidine Sedation in Older Adults

by Seyoon Kang, Yun Jeong Chae, Sun Kyung Park, Taek Geun Kim and Han Bum Joe

J. Clin. Med. 2022, 11(21), 6349; https://doi.org/10.3390/jcm11216349 - 27 Oct 2022

Cited by 4 | Viewed by 3829

Abstract

Older adults exhibit reduced physiological responses to beta-adrenergic stimulation and parasympathetic inhibition. This study aimed to investigate the effect of reducing the incidence of bradycardia in the atropine and ephedrine pretreatment group compared to the control group in older adults who received spinal anesthesia with intravenous dexmedetomidine. Overall, 102 older adults aged over 65 years were randomly divided into three groups, and saline (control group), atropine at 0.5 mg (atropine group), and ephedrine at 8 mg (ephedrine group) were administered intravenously to each group as pretreatment. Immediately after spinal anesthesia, dexmedetomidine loading and study drug injections were commenced. The primary outcome was the incidence of bradycardia (<50 beats per min) within 60 min following dexmedetomidine loading. The incidence of bradycardia requiring atropine treatment was significantly higher in the control group than in the atropine and ephedrine groups (27.3% vs. 6.1% and 8.8%, respectively; p = 0.035), and no difference was noted between the atropine and ephedrine groups. Therefore, if ephedrine or atropine is selected and used according to the patient’s condition and clinical situation, it may be helpful in preventing bradycardia during spinal anesthesia using dexmedetomidine in older patients. Full article

(This article belongs to the Special Issue Geriatric Anesthesia: Clinical Sciences)

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13 pages, 575 KiB

Open AccessArticle

Perioperative Factors Impact on Mortality and Survival Rate of Geriatric Patients Undergoing Surgery in the COVID-19 Pandemic: A Prospective Cohort Study in Indonesia

by Nancy Margarita Rehatta, Susilo Chandra, Djayanti Sari, Mayang Indah Lestari, Tjokorda Gde Agung Senapathi, Haizah Nurdin, Belindo Wirabuana, Bintang Pramodana, Adinda Putra Pradhana, Isngadi Isngadi, Novita Anggraeni, Kenanga Marwan Sikumbang, Radian Ahmad Halimi, Zafrullah Khany Jasa, Akhyar Hamonangan Nasution, Mochamat Mochamat and Purwoko Purwoko

J. Clin. Med. 2022, 11(18), 5292; https://doi.org/10.3390/jcm11185292 - 8 Sep 2022

Cited by 3 | Viewed by 2832

Abstract

Background: The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. Methods: A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan–Meier survival analysis. Results: We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality (p < 0.05) is COVID-19 (OR, 4.34; 95% CI, 1.04–18.07; p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03–5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96–7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32–5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32–8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p < 0.05. The six comorbidities that have log-rank p < 0.05 are moderate-to-severe renal disease (log-rank p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Geriatric Anesthesia: Clinical Sciences)

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