Title :

A multicentre observational study on management of general anaesthesia in elderly patients at high-risk of postoperative adverse outcomes.

Author(s) :

Molliex, Serge [Auteur]
Passot, Sylvie [Auteur]
Morel, Jerome [Auteur]
Futier, Emmanuel [Auteur]
Lefrant, Jean-Yves [Auteur]
Constantin Jean, Michel [Auteur]
Le Manach, Yannick [Auteur]
Pereira, Bruno [Auteur]

Journal title :

Anaesthesia, Critical Care & Pain Medicine

Abbreviated title :

Anaesth. Crit. Care Pain Med.

Publication date :

2018

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

INTRODUCTION: In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to ...
Show more >INTRODUCTION: In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged≥75 years. PATIENTS AND METHODS: A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients≥75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected. RESULTS: In total, 807 patients were included. Only 2% of patients [95% CI: 1-3] received GHDT in full accordance with guidelines. Depth of anaesthesia monitoring was largely performed (53% [95% CI: 50-56]). The multifaceted strategy of lung-protective ventilation combining low tidal volumes (6-8mL/kg), PEEP of 5-8cm cmH2O, and repeated recruitment manoeuvres, was performed in only 4% [95% CI: 3-5] of patients. A centre effect was a major determinant of variation concerning implementation of these strategies. DISCUSSION: In patients'≥75 years, strategies of anaesthesia optimisation are not in accordance with eligible guidelines. Implementation of these techniques varies independently of factors related to the patient or the type of surgery and may be dependent on the generated constraints.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
CHU Lille

Collections :

• Groupe de Recherche sur les formes Injectables et les Technologies Associées (GRITA) - ULR 7365

Research team(s) :

Innovation/évaluation des médicaments injectables

Submission date :

2019-02-26T17:06:54Z