老年麻醉-挑战与思考.ppt

老年患者麻醉 ---挑战与思考 王天龙 w_tl5595@ 首都医科大学宣武医院 老年患者麻醉-挑战之一血压如何维持？ 合并冠心病老年患者麻醉血压管理要点 ● 通过优化血流动力学指标维持心肌氧供需平衡，维持血压稳定 ● 冠心病患者血压下降需要逆转心肌氧供需失衡，过度强心治疗可能无益于这种状况的逆转 ● 血压维持水平参照术前平静状态下血压 大脑低灌注及缺血缺氧可以早期预警吗？ 老年麻醉-挑战之二围术期容量管理 围术期容量变化分析—术后容量状态 老年麻醉-挑战之三麻醉方法、安全镇静与术后认知 Sedation with Dexmedetomidine during Intrathecal Anesthesia may Improve Early Postoperative Cognitive Dysfunction in Elderly Patients undergoing Lower Limb Orthopedic Surgery (Submitted)Yu Lang MD.＊, Tian-Long Wang MD.?, Ya chao Xu MD. ?, Hui liang Shen MD.?, Background: The authors explored the safety and feasibility of Dexmedetomidine used for sedation during intrathecal anesthesia for elderly patients and investigated the effect of Dexmedetomidine on early postoperative cognitive function. Methods Sixty elderly patients were randomized into the DEX and control groups,. After intrathecal anesthesia, DEX was continuously infused intravenously for 10 min at a rate of 0.4 ?g.kg-1.h-1, and then the infusion rate was adjusted to 0.2-0.4 ?g.kg-1.h-1 to keep the Bispectral index (BIS) value around 80, while an equal volume of normal saline was continuously infused In the control group, Blood pressure, heart rate (HR), respiration rate(RR), blood oxygen saturation(SpO2), partial pressure of end-tidal carbon dioxide (PETCO2), and BIS values were recorded at six point. Neurocognitive function was evaluated before surgery, and 7 and 30 d after surgery using the Mini-mental State Examination. Results: In the DEX group, blood pressure was significantly decreased compared with that at T0 (P 0.05) during anesthesia, the BIS and The observers assessment of alertness/sedation scores (OAA/S) were significantly decreased within the group and between the groups (P 0.05), The DEX group showed a better cognitive functions at 7 d and at 1 month than those in controls (6.7% vs 13.3% and 3.3% vs 10.0%, respectively). Conclusions: Sedation with low-dose DEX is safe, feasible, and effective in elderly patients , and it may b