[The safety of geriatric anesthesia]

Perioperative abnormalities and complications were reviewed in 556 geriatric patients retrospectively to assess the safety of geriatric anesthesia. Preoperatively, the percentages of cases with cardiovascular and pulmonary abnormalities were 49.6% (276 cases) and 21.8% (121 cases) respectively. 77 percent of out patients (428 cases) were in the ASA class II physical status. The most common intraoperative complication was blood pressure instability and the incidence was noted to be of 34.8% (130 cases) with general anesthesia and of 15.8% (26 cases) with regional anesthesia. With general anesthesia, incidence for postoperative events such as non-fatal complications (i.e., sore throat and eye dryness), cardiovascular abnormalities and pulmonary disorders were found to be 39.0% (146 cases), 22.2% (83 cases) and 6.2% (23 cases) respectively. With regional anesthesia, the most common postoperative event was blood pressure instability (incidence: 21.2%, 35 cases). Total mortality rate of the first 15 postoperative days was 2.0% (11 cases). Mortality rate in elective and emergency surgery was 1.1% (5 cases) and 6.8% (6 cases) respectively. Causes of death were mainly related to illness deterioration (cancer and infection) or location of surgery. Death due to anesthetic mishap was nil in this study.

Most geriatric patients had more than one system or one organ dysfunction before operation. Cardiovascular instability was the most common intraoperative complication. Postoperative mortality correlates closely with the preoperative ASA physical status. Mortality rate was significantly higher in emergency cases than in elective cases. A thorough pre-operative assessment and proper perioperative management are mandatory in geriatric anesthesia.