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Critical Care |

Increased Hypotension Due to Age-Uncorrected Anesthetic Dosing in the Elderly: A Single Institutional Study

Joseph Heng, BS; Shamsuddin Akhtar, MD
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Yale School of Medicine, New Haven, CT


Chest. 2014;145(3_MeetingAbstracts):188A. doi:10.1378/chest.1835524
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Abstract

SESSION TITLE: Critical Care Posters III

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Previous studies have demonstrated that elderly patients over the age of 65 have decreased anesthetic requirements due to age related pharmacokinetic and pharmacodynamic changes. It was our impression that currently, anesthetic dosages are rarely corrected for age. We hypothesize that in our institution, anesthetics being given to patients undergoing general anesthesia are not rigorously corrected for age, thus leading to potential overdosing.

METHODS: We retrospectively reviewed the intraoperative anesthetic records of 101 female non-pregnant patients between the ages of 31-40 (n=51) and 71-80 (n=50) undergoing gynecologic surgeries.

RESULTS: When analyzing ASA I and II patients, there were no significant differences in the amounts of fentanyl and propofol administered between the two groups (p=0.35 and p=0.16). This resulted in a drop of 28 mmHg from 107 mmHg to 79 mmHg in the elderly group, 5 minutes after induction, in contrast to a 12 mmHg decrease from 101 mmHg to 89 mmHg in the younger group (p<0.01). When analyzing all patients, our results show that the amount of fentanyl administered was no different between the two groups (p=0.27), whereas elderly patients were given significantly less propofol and midazolam than their younger counterparts (both p<0.01). Despite the lower dosage of propofol and midazolam administered in the elderly, the average mean arterial pressure (MAP) fell 22 mmHg from 110 mmHg to 88 mmHg 5 minutes after induction, whereas in the younger group, the average MAP only decreased 11 mmHg from 102 mmHg to 91 mmHg (p<0.01). In addition, when we corrected for weight, our findings show that the amounts of propofol and fentanyl administered did not differ significantly between the two groups (p=0.10 and p=0.40).

CONCLUSIONS: Our findings confirm that anesthetic dosing is not being rigorously corrected for age, contributing to an increased frequency of hypotension and a possibly higher risk of morbidity and mortality in the elderly population.

CLINICAL IMPLICATIONS: The results of this pilot study should encourage more stringent protocols to appropriately dose elderly patients undergoing general anesthesia.

DISCLOSURE: The following authors have nothing to disclose: Joseph Heng, Shamsuddin Akhtar

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