Hemodynamic Effects of Continuous Spinal Anesthesia (CSA) Versus Continuous Epidural Anesthesia (CEA) Versus Combined Spinal and Epidural (CSE) in Orthopedic Surgery in the Elderly

Abstract

Elderly patients. who are arbitrarily defined as older than 55 years of age, are becoming an increasingly larger segment of society. Approximately one half of patients who reach 60 years of age will require surgery before they die.

Compared with younger patients, elderly patients may be at greater risk of peri operative complications because of age-related concomitant diseases and a generalized decline in organ function, which may manifest only with the added stress ofthe perioperative period. 1

Although morbidity and mortality of surgery in elderly patients are higher following surgery than that for their younger counterparts, these problems are usually due to concomitant disease processes such as heart disease, diabetes mellitus or renal failure rather than aging per se."

Regional anesthesia is an acceptable alternative to general anesthesia in alert and cooperative elderly patients especially those undergoing lower limb orthopedic surgeries. Selection of the anesthetic technique should be influenced not only by the patients' clinical condition and surgical requirements but also by the anesthetists' skill and experience.

Life threatening cardiovascular complications are a serious risk even for healthy patients during spinal/epidural anesthesia. The incidence of fatal CVS complications of epidural and spinal anesthesia is 1:10.000 and 1:7000 respectively.