Anesthesia for the patients 70 years of age and older undergoing coronary artery bypass grafting

• Published in: Nihon Rinshō Masui Gakkai shi Vol. 9; no. 3; pp. 236 - 241
• Main Authors: IZUMI, Hiromichi, HORIBE, Mayumi, YAMANOUE, Takao, TSUCHIYA, Taro
• Format: Journal Article
• Language: English
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 1989
• ISSN: 0285-4945; 1349-9149
• DOI: 10.2199/jjsca.9.236

Perioperative management for nineteen patients 70 years of age and older who electively underwent isolated coronary artery bypass grafting (CABG) from April, 1986 to August, 1988 (Group I) was evaluated retrospectively. Preoperative risk factors, intraoperative hemodynamics and postoperative courses of patients in Group I were compared with those of 46 patients less than 70 years of age who electively underwent CABG during the same period (Group II). Incidence of renal dysfunction, one of the preoperative risk factors, was significantly higher in Group I than in Group II. Cardiac index (CI) in Group I after pericardiotomy and just after discontinuation of CPB (cardiopulmonary bypass) was significantly less than those of Group II, suggesting that the load of operation and CPB are more in the elderly patients. Concerning about circulatory support, inotropics and IABP were required more frequently in Group I than in Group II. As a result, significant difference of CI between Group I and Group II disappeared around closure of sternum. That is, hemodynamics became satisfied with that usage of circulatory support. While in the postoperative period, incidence of renal failure or respiratory failure that were required peritoneal dialysis and prolonged mechanical ventilatory support respectively was significantly higher in Group I than in Group II. Period of catecholamine administration and ICU stay were also significantly longer in Group I than in Group II. Particularly concerning about renal function, the elderly patients suffering preoperative renal dysfunction and postoperative LOS simultaneously easily fell into fatal renal failure. These results suggest that the elderly patients have some difficult problems in the postoperative period and require more careful management.