[Anesthesia for geriatric patients : Part 2: anesthetics, patient age and anesthesia management]

Flexible diverticulotomy for Zenker's diverticulum - a bicentric study

INTRODUCTION

Flexible diverticulotomy is an established procedure for the treatment of Zenker's diverticulum. In a bicentric study, we investigated the development of the procedure since its introduction at the Ordensklinikum Linz Barmherzige Schwestern and Elisabethinen in 2010.

METHODS

All flexible diverticulotomies performed between January 2010 and December 2019 at the above-mentioned clinics were evaluated retrospectively. Patients were divided into two 5-year periods (2010-2014 and 2015-2019) and statistical tests were performed for comparison of data.

RESULTS

In all, 69 flexible diverticulotomies were performed. The procedure was technically successful in 93.5% of cases. No lethal outcome was encountered. Only 2 (2.9%) interventions led to serious complications which had to be treated in the intensive care unit. Mild complications occurred in 14.5% of cases. 54 patients were evaluated in the follow-up period; 11 (20.3%) patients experienced relapses of dysphagia. The primary intervention resulted in a significant improvement over the observation period. Patients in the second intervention group had shorter average hospital stays and longer recurrence-free intervals.

CONCLUSION

Flexible diverticulotomy is a safe and effective procedure for the treatment of Zenker's diverticulum. However, as the success rate appears to depend on the expertise and experience of the department, flexible diverticulotomy should be performed at centers with high caseloads.

Recovery and prediction of postoperative muscle power - is it still a problem?

BACKGROUND

In the postoperative period, immediate recovery of muscular power is essential for patient safety, but this can be affected by anaesthetic drugs, opioids and neuromuscular blocking agents (NMBA). In this cohort study, we evaluated anaesthetic and patient-related factors contributing to reduced postoperative muscle power and pulse oximetric saturation.

METHODS

We prospectively observed 615 patients scheduled for minor surgery. Premedication, general anaesthesia and respiratory settings were standardized according to standard operating procedures (SOP). If NMBAs were administered, neuromuscular monitoring was applied to establish a Train of four (TOF)-Ratio of >0.9 before extubation. After achieving a modified fast track score > 10 at 4 time points up to 2 h postoperatively, we measured pulse oximetric saturation and also static and dynamic muscle power, using a high precision digital force gauge. Loss of muscle power in relation to the individual preoperative baseline value was analysed in relation to patient and anaesthesia-related factors using the T-test, simple and multiple stepwise regression analysis.

RESULTS

Despite having achieved a TOF ratio of >0.9 a decrease in postoperative muscle power was detectable in most patients and correlated with reduced postoperative pulse oximetric saturation. Independent contributing factors were use of neuromuscular blocking agents (p < 0.001), female gender (p = 0.001), TIVA (p = 0.018) and duration of anaesthesia >120 min (p = 0.019).

CONCLUSION

Significant loss of muscle power and reduced pulse oximetric saturation are often present despite a TOF-Ratio > 0.9. Gender differences are also significant. A modified fast track score > 10 failed to predict recovery of muscle power in most patients.

TRIAL REGISTRATION

German Clinical Trial Register DRKS-ID DRKS00006032 ; Registered: 2014/04/03.

[Anesthesiological care of trauma patients in orthogeriatric co-management]

Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient.

[Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients]

Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient.