TY - JOUR
T1 - Does intravenous induction dosing among patients undergoing gastrointestinal surgical procedures follow current recommendations
T2 - A study of contemporary practice
AU - Akhtar, Shamsuddin
AU - Liu, Jia
AU - Heng, Joseph
AU - Dai, Feng
AU - Schonberger, Robert B.
AU - Burg, Matthew M.
N1 - Funding Information:
Disclosure: This work was supported in part by Clinical and Translational Science Award grant UL1 RR024139 from the National Center for Advancing Translational Sciences at the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the policy or views of the National Institutes of Health or the United States government.
Publisher Copyright:
© 2016 Elsevier Inc. All rights reserved.
Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Study objective It is recommended to correct intravenous induction doses by up to 50% for patients older than 65 years. The objectives were to determine (a) the degree to which anesthesia providers correct induction doses for age and (b) additionally adjust for American Society of Anesthesiologists physical status (ASA-PS) class (severity of illness) and (c) whether postinduction hypotension is more common among patients aged > 65. Design Retrospective chart review. Setting Academic medical center. Patients A total of 1869 adult patients receiving general anesthesia for GI surgical procedures from February 2013 to January 2014. Measurements Patients were divided into 3 age groups (age < 65, 65-79, ≥ 80 years) and then further stratified into ASA-PS class (I/II vs III/IV). Multiple pairwise comparisons were conducted using Welch t tests for continuous variables to determine whether dosing was different for the older groups vs the younger group; separate analyses were performed within and across ASA-PS class. This approach was also used to determine differences in mean arterial pressure change in the older groups vs the younger group, whereas the rates of hypotension among different age groups were compared by Cochran-Armitage trend test. Main results No significant decrease in dosing between age groups was observed for fentanyl and midazolam. For propofol, there was a significantly lower dosing for older patients: 17% for patients aged 65-79 and 29% for those aged > 80, which was still in less than the recommendations. An inverse relationship was observed between propofol dosing and ASA-PS class, but no consistent relationship was noted for fentanyl and midazolam. There were a significantly larger drop in mean arterial pressure and a greater likelihood of hypotension following induction in patients aged 65-79 years and > 80 years as compared with those aged < 65 years. Conclusions This study shows that the administered dose of anesthetic induction agents is significantly higher than that recommended for patients older than 65 years. This failure to age-adjust dose may contribute to hypotensive episodes.
AB - Study objective It is recommended to correct intravenous induction doses by up to 50% for patients older than 65 years. The objectives were to determine (a) the degree to which anesthesia providers correct induction doses for age and (b) additionally adjust for American Society of Anesthesiologists physical status (ASA-PS) class (severity of illness) and (c) whether postinduction hypotension is more common among patients aged > 65. Design Retrospective chart review. Setting Academic medical center. Patients A total of 1869 adult patients receiving general anesthesia for GI surgical procedures from February 2013 to January 2014. Measurements Patients were divided into 3 age groups (age < 65, 65-79, ≥ 80 years) and then further stratified into ASA-PS class (I/II vs III/IV). Multiple pairwise comparisons were conducted using Welch t tests for continuous variables to determine whether dosing was different for the older groups vs the younger group; separate analyses were performed within and across ASA-PS class. This approach was also used to determine differences in mean arterial pressure change in the older groups vs the younger group, whereas the rates of hypotension among different age groups were compared by Cochran-Armitage trend test. Main results No significant decrease in dosing between age groups was observed for fentanyl and midazolam. For propofol, there was a significantly lower dosing for older patients: 17% for patients aged 65-79 and 29% for those aged > 80, which was still in less than the recommendations. An inverse relationship was observed between propofol dosing and ASA-PS class, but no consistent relationship was noted for fentanyl and midazolam. There were a significantly larger drop in mean arterial pressure and a greater likelihood of hypotension following induction in patients aged 65-79 years and > 80 years as compared with those aged < 65 years. Conclusions This study shows that the administered dose of anesthetic induction agents is significantly higher than that recommended for patients older than 65 years. This failure to age-adjust dose may contribute to hypotensive episodes.
KW - Elderly
KW - Gastrointestinal surgery
KW - Geriatric anesthesia
KW - Hypotension
KW - Intravenous anesthetics
KW - Octagenarians
KW - Propofol
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U2 - 10.1016/j.jclinane.2016.02.001
DO - 10.1016/j.jclinane.2016.02.001
M3 - Article
C2 - 27555166
AN - SCOPUS:84968542482
SN - 0952-8180
VL - 33
SP - 208
EP - 215
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
ER -