[Postoperative complications after femoral neck fracture in advanced elderly patients].

BACKGROUND: We studied the prevalence of postoperative complications and the predictor for the occurrence of postoperative delirium in patients who had received surgery for femoral neck fracture. METHODS: A retrospective study, covering the period between January 1, 2005 and March 31, 2006, was carried out 50 in patients of advanced age treated for femoral neck fracture. We investigated main symptoms of postoperative complications. We also compared postoperative delirium group (D group) with no delirium group (ND group). RESULTS: The following results were obtained. Main postoperative complications were delirium, hypotension and hypoxia. And only one death case was included. In postoperative delirium, there was not a wide difference between the two groups except for hearing loss. CONCLUSIONS: Our results indicate that it might be possible to prevent postoperative complications by careful perioperative management. Hearing loss preoperatively was a risk factor of postoperative delirium in advanced elderly patients.

[Causes of postoperative delirium after abdominal surgery in elderly patients].

BACKGROUND: There are many causes for postoperative delirium in elderly patients. Hypotension is considered as one of the causes. In our retrospective study, hypotension during operation was not taken care of strictly. Slight hypotension was observed every so often. We recognized that the drop of cerebral blood flow due to hypotension and duration of hypotension were risk factors of postoperative delirium. METHODS: We did a retrospective study, covering the period between April 1, 2005 and March 31, 2006, in 30 elderly patients for elective laparotomy. We compared postoperative delirium group (D group) with no delirium group (ND group). RESULTS: There were great differences in transfusion, fluid infusion, anesthesia time, operation time, blood loss, extreme hypotension and the duration of hypotension between the two groups. CONCLUSIONS: Our results indicate that permissive hypotension induced the drop of cerebral blood flow and it can be a risk factor of postoperative delirium in elderly patients. To prevent extreme hypotension, to decrease duration of hypotension, and to raise the blood pressure quickly are very important to decrease postoperative delirium in elderly patients.

[Anesthetic management for cesarean section involving placenta previa].

BACKGROUND: There are few consistent anesthetic guidelines how to manage cesarean section in the presence of placenta previa. Main problem may be hemorrhage, as occasionary unexpected massive bleeding leads to life-threatening hemorrhage. METHODS: We investigated retrospectively, covering the period between April 1, 2001 and September 30, 2005, 30 women with placenta previa who had undergone cesarean section. RESULTS: Comparing general anesthesia with regional anesthesia, there was not a significant difference between the two. Comparing totalis (T) with partial (P) in the classification of placenta previa, infusion and hemorrhage in T group were more pronounced than those in the P group. Regarding these operations performed during the weekend or at night, shortage of supportive anesthesiologist was pointed out. CONCLUSIONS: These results indicate that regional and general anesthesia did not differ in the intraoperative incidence. In all cases at least two anesthesiologists and at least two venous lines are necessary to manage cesarean section in the presence of placenta previa.

[A new device for pediatric one-lung anesthesia].

We were using an L type connector with single side port with a Fogarty catheter in pediatric one-lung anesthesia. This method was not as good as roported, because modification of catheter position was rather too difficult during operation. We have made a new device with two side ports to improve weak points of the old device. We used this device for pediatric one-lung anesthesia, and obtained good results.

[A comparison of combined spinal-epidural anesthesia with epidural anesthesia for postoperative pain relief after transurethral resection of the prostate].

BACKGROUND: We compared combined spinal-epidural anesthesia (S group) and epidural anesthesia (E group) in terms of pain control after transurethral resection of the prostate (TUR-P). METHODS: All 32 patients received 0.2% ropivacaine at a rate of 2 ml x hr(-1) by a portable disposable pump postoperatively. RESULTS: S group was superior to E group in urethral pain control within three hours after operation. E group was superior to S group in decrease of back pain over six hours after operation. Fifteen patients (47%) suffered from irritability or low back pain and needed rescue analgesics. CONCLUSIONS: Our result indicates that 0.2% ropivacaine at a rate of 2 ml x hr(-1) is not satisfactory to relieve the postoperative pain. Long acting local anesthetics for spinal anesthesia are not suitable for TUR-P. Supplemental administration of opioid to epidural space or higher rate of continuous epidural infusor after operation might be better analgesic choice for TUR-P.

[Prognostic factors in patients with massive intraoperative blood loss].

BACKGROUND: Massive blood loss during surgery might affect the prognosis of the patient. METHODS: Fifty-seven patients with massive blood loss of more than 10,000 g were the subjects of the study. We compared the postoperative complication and prognosis for the following 3 groups. Group 1 is without complications (n = 17), Group 2 is alive with complications (n = 20), and Group 3 is the death group (n = 20). The following results were obtained. RESULTS: Transfusion, blood loss and urine output were prognosis decision factors. And we found out that the duration of low hemoglobin level (Hb < 7.0 g.dl-1) was closely related to the prognosis. CONCLUSIONS: It will be concluded that the duration of low hemoglobin level was one of the most important parameters to determine the prognosis of patients with massive intraoperative bleeding.