Postoperative Management of Intravenous Sedation in Elderly Patients

• Published in: Ronen Shika Igaku Vol. 15; no. 3; pp. 254 - 259
• Main Authors: Kondo, Takanari, Hiura, Yoshitake, Ishida, Yoshiyuki, Kawanami, Shinji, Ono, Satoshi, Kawada, Itaru
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of Gerodontology 31.03.2001
• Subjects: Aspiration; Elderly patients; Intravenous sedation; Postoperative management
• ISSN: 0914-3866; 1884-7323
• DOI: 10.11259/jsg1987.15.254

The purpose of the present study is to clarify the postoperative process of recovery in elderly patients with intravenous sedation. A clinico-statistical analysis was performed as to postoperative complications during 24 hours following intravenous sedation in 304 cases (97 male and 207 female) of 65 years and over, admitted patients in our hospital over a period of 7 years 6 months (March 1994-September 2000). Perioperative complications included decrease of SpO2 less than 93%, aspiration, partial upper airway obstruction by relaxation of the tongue, and more than 20% decrease of systolic blood pressure. In the same way, postoperative complications included decrease of SpO2 less than 93%, snoring, disorder of equilibrium function, and aspiration. The average age of the patients was 73.2±6.6 (S.D.) years old. Out of the 304 cases, 292 cases (95.7%) had some basic diseases. The mean doses of midazolam, diazepam and flunitrazepam administered were 0.045, 0.093 and 0.008 mg/kg, respectively. No significant difference was recognized between the amount of sedatives and compli-cations. Out of the 304 cases, 56 cases (18.4%) showed complications during the periopera-tive period, and 74 cases (24.3%) showed complications during the postoperative period. On and after two hours, 25 cases showed complications, and 9 cases showed snoring during the night. With the cases who had aspiration during the postoperative complications, a cerebral infarction occurred in 83% of cases. Aspiration might be caused by incom- petence of the larynx and so on easily with the elderly patients. Therefore, attention after the intravenous sedation was necessary for postoperative bleeding, symptom- less aspiration of the mouth contents, and the intake of food. From the above, the difference of physiological function in elderly patients is too much, so it is difficult to predict the extended effect of the sedative, and the appearance of the complications. Complications after intravenous sedation which were thought to result from the sedative, appeared for 4 or 5 hours. In conclusion, it is necessary to keep postoperative management for 4 or 5 hours, or hospitalization following intravenous sedation in elderly patients.