A multicentre observational study on management of general anaesthesia in elderly patients at high-risk of postoperative adverse outcomes

Serge Molliex (1, 2) , Passot, Sylvie (1, 2) , Jérôme Morel (1, 2) , Emmanuel Futier (3, 4) , Jean Yves Lefrant (5) , Jean-Michel Constantin (3, 4) , Yannick Le Manach (6) , Bruno Pereira (3)

1 CHU de Saint-Etienne - Centre Hospitalier Universitaire de Saint-Etienne
2 UJM - Université Jean Monnet - Saint-Étienne
3 CHU Clermont-Ferrand
4 UCA - Université Clermont Auvergne
5 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
6 McMaster University [Hamilton, Ontario]

Introduction: In elderly patients, goal-directed haemodynamic therapy (GDHT), depth of anaesthesia monitoring and lung-protective ventilation have been shown to improve postoperative outcomes. The aim of this study was to evaluate current practices concerning strategies of anaesthesia optimisation in patients aged≥75 years.Patients and methods: A multicentre observational study was performed from February to May 2015 in 23 French academic centres. On 30 consecutive days in each centre, patients≥75 years with at least one major comorbidity undergoing elective or emergency procedures (femoral-neck fractures surgery, intraperitoneal abdominal surgery or vascular surgery) were included. Patient characteristics and data related to GHDT, management of hypotension, monitoring of temperature and depth of anaesthesia, lung ventilation, point of care haemoglobin testing were collected.Results: In total, 807 patients were included. Only 2% of patients [95% CI: 1-3] received GHDT in full accordance with guidelines. Depth of anaesthesia monitoring was largely performed (53% [95% CI: 50-56]). The multifaceted strategy of lung-protective ventilation combining low tidal volumes (6-8mL/kg), PEEP of 5-8cm cmH2O, and repeated recruitment manoeuvres, was performed in only 4% [95% CI: 3-5] of patients. A centre effect was a major determinant of variation concerning implementation of these strategies.Discussion: In patients'≥75 years, strategies of anaesthesia optimisation are not in accordance with eligible guidelines. Implementation of these techniques varies independently of factors related to the patient or the type of surgery and may be dependent on the generated constraints.

Keywords: Anaesthesia management: Monitoring; Haemodynamic; Ventilation.; Aged

Domains: Life Sciences [q-bio]; Microbiology and Parasitology; Bacteriology; Life Sciences [q-bio]; Microbiology and Parasitology; Virology; Life Sciences [q-bio]; Microbiology and Parasitology; Parasitology; Life Sciences [q-bio]; Human health and pathology; Cardiology and cardiovascular system; Life Sciences [q-bio]; Human health and pathology; Emerging diseases; Life Sciences [q-bio]; Human health and pathology; Infectious diseases

Serge Molliex, Passot, Sylvie, Jérôme Morel, Emmanuel Futier, Jean Yves Lefrant, et al.. A multicentre observational study on management of general anaesthesia in elderly patients at high-risk of postoperative adverse outcomes. Anaesthesia Critical Care & Pain Medicine, 2019, ⟨10.1016/j.accpm.2018.05.012⟩. ⟨hal-02385406⟩