OBJECTIVE: A prospective study was undertaken to review the use of combined lumbar spinal and thoracic high-epidural regional anesthesia in high-risk patients who underwent gastrointestinal/colorectal surgery from 2004 to 2006. METHODS: Twelve high-risk patients underwent 13 gastrointestinal/colorectal surgical procedures, using a regional anesthetic technique, which consisted of a thoracic epidural and lumbar subarachnoid block. All patients were classified as high risk based on anesthetic assessment (American Society of Anesthesiologists (ASA) score 3 or 4). RESULTS: Six (46.2%) of the patients were men, and the overall median age was 86 years. Ten (76.9%) patients presented as emergencies, whereas only three (23.1%) patients underwent elective procedures. All patients subjectively rated their postoperative pain relief as effective. The 30-day mortality was 2 (15.4%); however, both of these patients refused initial treatment. Only one (7.7%) patient required delayed ITU admission for respiratory support (CPAP). None of the patients required intubation at any stage. There were two (15.4%) minor and two (15.4%) major early complications and only one (7.7%) delayed complication to date. Median length of stay was 7 days. Two (15.4%) patients had delayed discharge dates, for social reasons. DISCUSSION: These patients demonstrated early postoperative recovery, with effective analgesia, no requirements for intubation, and lower morbidity and mortality rates than similar studies of high-risk patients who underwent procedures using general anesthesia. Using this technique, patients were managed appropriately in HDU and the surgical ward, without affecting their overall length of hospital stay. CONCLUSIONS: This study supports the role of regional anesthetic techniques, combined with targeted, minimally invasive surgery--particularly for the management of high-risk patients presenting in the emergency setting.
OBJECTIVE: A prospective study was undertaken to review the use of combined lumbar spinal and thoracic high-epidural regional anesthesia in high-risk patients who underwent gastrointestinal/colorectal surgery from 2004 to 2006. METHODS: Twelve high-risk patients underwent 13 gastrointestinal/colorectal surgical procedures, using a regional anesthetic technique, which consisted of a thoracic epidural and lumbar subarachnoid block. All patients were classified as high risk based on anesthetic assessment (American Society of Anesthesiologists (ASA) score 3 or 4). RESULTS: Six (46.2%) of the patients were men, and the overall median age was 86 years. Ten (76.9%) patients presented as emergencies, whereas only three (23.1%) patients underwent elective procedures. All patients subjectively rated their postoperative pain relief as effective. The 30-day mortality was 2 (15.4%); however, both of these patients refused initial treatment. Only one (7.7%) patient required delayed ITU admission for respiratory support (CPAP). None of the patients required intubation at any stage. There were two (15.4%) minor and two (15.4%) major early complications and only one (7.7%) delayed complication to date. Median length of stay was 7 days. Two (15.4%) patients had delayed discharge dates, for social reasons. DISCUSSION: These patients demonstrated early postoperative recovery, with effective analgesia, no requirements for intubation, and lower morbidity and mortality rates than similar studies of high-risk patients who underwent procedures using general anesthesia. Using this technique, patients were managed appropriately in HDU and the surgical ward, without affecting their overall length of hospital stay. CONCLUSIONS: This study supports the role of regional anesthetic techniques, combined with targeted, minimally invasive surgery--particularly for the management of high-risk patients presenting in the emergency setting.
Authors: K C H Fearon; O Ljungqvist; M Von Meyenfeldt; A Revhaug; C H C Dejong; K Lassen; J Nygren; J Hausel; M Soop; J Andersen; H Kehlet Journal: Clin Nutr Date: 2005-04-21 Impact factor: 7.324
Authors: P Hannemann; K Lassen; J Hausel; S Nimmo; O Ljungqvist; J Nygren; M Soop; K Fearon; J Andersen; A Revhaug; M F von Meyenfeldt; C H C Dejong; C Spies Journal: Acta Anaesthesiol Scand Date: 2006-08-25 Impact factor: 2.105
Authors: Brian M Block; Spencer S Liu; Andrew J Rowlingson; Anne R Cowan; John A Cowan; Christopher L Wu Journal: JAMA Date: 2003-11-12 Impact factor: 56.272