Læknablaðið - 15.10.1981, Blaðsíða 4

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LÆKNABLADID
Nýr doktor í læknisfræði — Porsteinn Svörfuður Stefánsson
Hinn 30. apríl 1981 varði Þorsteinn Svörfuður
Stefánsson doktorsritgerð við Medicinska Fa-
kulteten, Göteborgs Universitet. Ritgerðin
nefnist Anesthesia and Surgery in the Geria-
tric Patient. A hemodynamic and metabolic
study in the female with hip fracture. Útdrátt-
ur úr ritgerðinni fer hér á eftir:
The number of patients requiring anesthesia
and surgery for hip fracture has steadily
increased due to an increase in the geriatric
population. Hip fracture is more common in
females, who also have a longer life expectan-
cy than males.
In the present study anesthetic risk factors
and optimal anesthetic management of the
female geriatric patient with hip fracture was
evaluated. The preanesthetic evaluation inclu-
ded 204 patients (mean age 81.0, range 70-100
years). The per-and postanesthetic study of
hemodynamic (pressures, and resistances in
systemic and pulmonary vasculature, cardiac
output, stroke volume, left and right ventricu-
lar work), respiratory (alveolo-arterial 02
difference, blood gases, pulmonary venous
admixture) and metabolic (oxygen consumpti-
on, blood and skeletal muscle levels of glyco-
genolytic metabolites and muscle levels of
high energy phosphagens) responses to keta-
mine, halothane or enflurane anesthesia or
neurolept or epidural analgesia, was perfor-
med on 40 randomly selected patients. Post-
operative mortality rate was studied in 169
patients for 4 years and compared to that of a
control group of patients.
Preoperative evaluation revealed a high
prevalence of pathological findings (92 %),
dominated by cardiovascular disturbances
(78 %) and senile dementia (37 %). The majo-
rity of patients (87 %) were receiving drug
therapy. Electrolyte disturbances, anemia and
hypoxia were common.
The hemodynamic study showed increased
systemic vascular resistance and low systolic
blood pressure. The calculated myocardial
work for both ventricles was low due to
stroke voiume and cardiac output. Metabolic
evaluation showed that these elderly females
had lower levels of glycogenolytic metabolites
and high energy phosphagens in their skeletal
muscle than young females.
During anesthesia and surgery ketamine
increased cardiac work, cardiac output, oxyen
consumption and blood and tissue glucose
levels. Halothane and enflurane anesthesia
resulted in myocardial depression, associated
with a decrease in oxygen consumption whe-
reas systemic vascular resistance did not
change. Increased substrate mobilization was
seen, reaching the highest levels in the early
postanesthetic period. During neurolept and
epidural analgesia cardiovascular parameters,
remained mainly unchanged. However, in the
neurolept group postoperative respirtory de-
pression was seen together with signs of
increased sympathetic activity. Thus oxygen
consumption and cardiac output were increa-