Management of Continuous Spinal Anesthesia for Geriatric Surgery

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SURGERY is considered in aged patients only when pathologic conditions supervene upon the involutionary changes that normally result from advancing years. Aged patients are classified as poor surgical risks because aging narrows the limits of physiologic response and increases the danger of surgery and anesthesia.

In selecting anesthesia for the aged patient, the status of his respiratory and circulatory systems must be carefully evaluated. The heart may be unable to withstand unusual stress, as simple atrophy of the heart and degenerative changes of the coronary vessels often are present.1 Arteriosclerotic changes in the coronary and cerebral vessels form the groundwork for potentially catastrophic events should the blood pressure be allowed to fall precipitously and should it remain at hypotensive levels for any considerable time.* Hypotension is predisposed to by loss of elasticity of the peripheral vessels which impairs the rapid compensatory vasoconstrictor response to blood loss.

Spinal anesthesia by the continuous catheter technic provides safe anesthesia for operations in the abdomen, pelvis, and lower extremities of patients who are poor surgical risks. The indwelling catheter permits small and repeated injections of the anesthetic agents, thereby permitting the dosage to be adjusted specifically to each patient. With a segmental type of anesthesia2 using minimal amounts of anesthetic agent, the surgeon operates under ideal surgical conditions, and little if any hypotensive effect of the anesthetic is noted. The patient is awake and cooperative; therefore, the protective reflexes are not disturbed. The small doses of anesthetic agent injected make it possible to terminate . . .



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