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Local and Regional Anesthesia in the Elderly

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Complications of Regional Anesthesia

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References

  1. Roy RC. Choosing general versus regional anesthesia for the elderly. Anesthesiol Clin North America. 2000;18:91–104, vii.

    Google Scholar 

  2. Gustafson Y, Berggren D, Brannstrom B, Bucht G, Norberg A, Hansson LI, Winblad B. Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc. 1988;36:525–30.

    Article  CAS  PubMed  Google Scholar 

  3. O’Keeffe ST, Ni CA. Postoperative delirium in the elderly. Br J Anaesth. 1994;73:673–87.

    Article  PubMed  Google Scholar 

  4. Hole A, Terjesen T, Breivik H. Epidural versus general anaesthesia for total hip arthroplasty in elderly patients. Acta Anaesthesiol Scand. 1980;24:279–87.

    Article  CAS  PubMed  Google Scholar 

  5. Papaioannou A, Fraidakis O, Michaloudis D, Balalis C, Askitopoulou H. The impact of the type of anaesthesia on cognitive status and delirium during the first postoperative days in elderly patients. Eur J Anaesthesiol. 2005;22:492–9.

    Article  CAS  PubMed  Google Scholar 

  6. Haan J, van Kleef JW, Bloem BR, Zwartendijk J, Lanser JB, Brand R, van der Does I, Krul EJ, Elshove HM, Moll AC. Cognitive function after spinal or general anesthesia for transurethral prostatectomy in elderly men. J Am Geriatr Soc. 1991;39:596–600.

    Article  CAS  PubMed  Google Scholar 

  7. Fong HK, Sands LP, Leung JM. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg. 2006;102:1255–66.

    Article  PubMed  Google Scholar 

  8. Sprung J, Gajic O, Warner DO. Review article: age related alterations in respiratory function—anesthetic considerations. Can J Anaesth. 2006;53:1244–57.

    Article  PubMed  Google Scholar 

  9. Halaszynski TM. Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia. Curr Opin Anaesthesiol. 2009;22:594–9.

    Article  PubMed  Google Scholar 

  10. Rasmussen LS, Johnson T, Kuipers HM, Kristensen D, Siersma VD, Vila P, Jolles J, Papaioannou A, Abildstrom H, Silverstein JH, Bonal JA, Raeder J, Nielsen IK, Korttila K, Munoz L, Dodds C, Hanning CD, Moller JT. Does anaesthesia cause postoperative cognitive dysfunction? A randomised study of regional versus general anaesthesia in 438 elderly patients. Acta Anaesthesiol Scand. 2003;47:260–6.

    Article  CAS  PubMed  Google Scholar 

  11. Gulur P, Nishimori M, Ballantyne JC. Regional anaesthesia versus general anaesthesia, morbidity and mortality. Best Pract Res Clin Anaesthesiol. 2006;20:249–63.

    Article  PubMed  Google Scholar 

  12. Chung F, Meier R, Lautenschlager E, Carmichael FJ, Chung A. General or spinal anesthesia: which is better in the elderly? Anesthesiology. 1987;67:422–7.

    Article  CAS  PubMed  Google Scholar 

  13. Cohendy R, Brougere A, Cuvillon P. Anaesthesia in the older patient. Curr Opin Clin Nutr Metab Care. 2005;8:17–21.

    Article  CAS  PubMed  Google Scholar 

  14. Modig J, Borg T, Karlstrom G, Maripuu E, Sahlstedt B. Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg. 1983;62:174–80.

    Article  CAS  PubMed  Google Scholar 

  15. Modig J, Maripuu E, Sahlstedt B. Thromboembolism after total hip replacement: a prospective investigation of 94 patients with emphasis of the efficacy of lumbar epidural anesthesia in prophylaxis. Reg Anesth. 1986;11:72–9.

    Google Scholar 

  16. Keith I. Anaesthesia and blood loss in total hip replacement. Anaesthesia. 1977;32:444–50.

    Article  CAS  PubMed  Google Scholar 

  17. Sorenson RM, Pace NL. Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis. Anesthesiology. 1992;77:1095–104.

    Article  CAS  PubMed  Google Scholar 

  18. Matot I, Oppenheim-Eden A, Ratrot R, Baranova J, Davidson E, Eylon S, Peyser A, Liebergall M. Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. Anesthesiology. 2003;98:156–63.

    Article  PubMed  Google Scholar 

  19. Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high-risk surgical patients. Anesthesiology. 1987;66:729–36.

    Article  CAS  PubMed  Google Scholar 

  20. Garcia Collada JC, Pereda Marin RM, Miralles Serrano EM, Garrote Martinez AI, Pacheco Lopez JF. Axillary brachial plexus block in an elderly patient with a previous 48-h standing acute myocardial infarct. Acta Anaesthesiol Scand. 2004;48:387–8.

    Article  CAS  PubMed  Google Scholar 

  21. Bode Jr RH, Lewis KP, Zarich SW, Pierce ET, Roberts M, Kowalchuk GJ, Satwicz PR, Gibbons GW, Hunter JA, Espanola CC. Cardiac outcome after peripheral vascular surgery. Comparison of general and regional anesthesia. Anesthesiology. 1996;84:3–13.

    Article  PubMed  Google Scholar 

  22. Breen P, Park KW. General anesthesia versus regional anesthesia. Int Anesthesiol Clin. 2002;40:61–71.

    Article  PubMed  Google Scholar 

  23. Nielsen KC, Steele SM. Outcome after regional anaesthesia in the ambulatory setting—is it really worth it? Best Pract Res Clin Anaesthesiol. 2002;16:145–57.

    Article  PubMed  Google Scholar 

  24. Brull SJ. Choice of regional versus general anesthesia. In: McLeskey CH, editor. Geriatric anesthesiology. Baltimore: Williams & Wilkins; 1997. p. 361–6.

    Google Scholar 

  25. Kanto J, Maenpaa M, Mantyla R, Sellman R, Valovirta E. Effect of age on the pharmacokinetics of diazepam given in conjunction with spinal anesthesia. Anesthesiology. 1979;51:154–9.

    Article  CAS  PubMed  Google Scholar 

  26. Arisaka H, Sakuraba S, Takeda J. Effects of spinal anesthesia on the electroencephalogram in the elderly. Acta Anaesthesiol Belg. 2008;59:15–7.

    CAS  PubMed  Google Scholar 

  27. Kurup V, Ramani R, Atanassoff PG. Sedation after spinal anesthesia in elderly patients: a preliminary observational study with the PSA-4000. Can J Anaesth. 2004;51:562–5.

    Article  PubMed  Google Scholar 

  28. Sieber FE, Gottshalk A, Zakriya KJ, Mears SC, Lee H. General anesthesia occurs frequently in elderly patients during propofol-based sedation and spinal anesthesia. J Clin Anesth. 2010;22:179–83.

    Article  PubMed  Google Scholar 

  29. Jacobs JR, Reves JG, Marty J, White WD, Bai SA, Smith LR. Aging increases pharmacodynamic sensitivity to the hypnotic effects of midazolam. Anesth Analg. 1995;80:143–8.

    CAS  PubMed  Google Scholar 

  30. Maitre PO, Buhrer M, Thomson D, Stanski DR. A three-step approach combining Bayesian regression and NONMEM population analysis: application to midazolam. J Pharmacokinet Biopharm. 1991;19:377–84.

    Article  CAS  PubMed  Google Scholar 

  31. Bell GD, Spickett GP, Reeve PA, Morden A, Logan RF. Intravenous midazolam for upper gastrointestinal endoscopy: a study of 800 consecutive cases relating dose to age and sex of patient. Br J Clin Pharmacol. 1987;23:241–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. CPS: compendium of pharmaceuticals and specialties. 38th ed. Ottawa: Canadian Pharmacists Association; 2003. p. 1003–8.

    Google Scholar 

  33. White PF, Boure B. Outpatient anesthesia for geriatric patients. In: McLeskey CH, editor. Geriatric anesthesiology. Baltimore: Williams & Wilkins; 1997. p. 441–57.

    Google Scholar 

  34. Munoz HR, Dagnino JA, Rufs JA, Bugedo GJ. Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients. Reg Anesth. 1992;17:139–42.

    CAS  PubMed  Google Scholar 

  35. Fernandez-Galinski D, Rue M, Moral V, Castells C, Puig MM. Spinal anesthesia with bupivacaine and fentanyl in geriatric patients. Anesth Analg. 1996;83:537–41.

    Article  CAS  PubMed  Google Scholar 

  36. Pavlin DJ, Coda B, Shen DD, Tschanz J, Nguyen Q, Schaffer R, Donaldson G, Jacobson RC, Chapman CR. Effects of combining propofol and alfentanil on ventilation, analgesia, sedation, and emesis in human volunteers. Anesthesiology. 1996;84:23–37.

    Article  CAS  PubMed  Google Scholar 

  37. Vinik HR, Bradley Jr EL, Kissin I. Triple anesthetic combination: propofol-midazolam-alfentanil. Anesth Analg. 1994;78:354–8.

    Article  CAS  PubMed  Google Scholar 

  38. McHardy FE, Fortier J, Chung F, Krishnathas A, Marshall SI. A comparison of midazolam, alfentanil and propofol for sedation in outpatient intraocular surgery. Can J Anaesth. 2000;47:211–4.

    Article  CAS  PubMed  Google Scholar 

  39. Rewari V, Madan R, Kaul HL, Kumar L. Remifentanil and propofol sedation for retrobulbar nerve block. Anaesth Intensive Care. 2002;30:433–7.

    CAS  PubMed  Google Scholar 

  40. Aydin ON, Ugur B, Kir E, Ozkan SB. Effect of single-dose fentanyl on the cardiorespiratory system in elderly patients undergoing cataract surgery. J Clin Anesth. 2004;16:98–103.

    Article  CAS  PubMed  Google Scholar 

  41. Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, Billard V, Hoke JF, Moore KH, Hermann DJ, Muir KT, Mandema JW, Shafer SL. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997;86:10–23.

    Article  CAS  PubMed  Google Scholar 

  42. Krenn H, Deusch E, Jellinek H, Oczenski W, Fitzgerald RD. Remifentanil or propofol for sedation during carotid endarterectomy under cervical plexus block. Br J Anaesth. 2002;89:637–40.

    Article  CAS  PubMed  Google Scholar 

  43. Mingus ML, Monk TG, Gold MI, Jenkins W, Roland C. Remifentanil versus propofol as adjuncts to regional anesthesia. Remifentanil 3010 Study Group. J Clin Anesth. 1998;10:46–53.

    Article  CAS  PubMed  Google Scholar 

  44. Marrocco-Trischitta MM, Bandiera G, Camilli S, Stillo F, Cirielli C, Guerrini P. Remifentanil conscious sedation during regional anaesthesia for carotid endarterectomy: rationale and safety. Eur J Vasc Endovasc Surg. 2001;22:405–9.

    Article  CAS  PubMed  Google Scholar 

  45. Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005;18:412–8.

    Article  PubMed  Google Scholar 

  46. Kunisawa T, Hanada S, Kurosawa A, Suzuki A, Takahata O, Iwasaki H. Dexmedetomidine was safely used for sedation during spinal anesthesia in a very elderly patient. J Anesth. 2010;24:938–41.

    Article  PubMed  Google Scholar 

  47. Hong JY, Kim WO, Yoon Y, Choi Y, Kim SH, Kil HK. Effects of intravenous dexmedetomidine on low-dose bupivacaine spinal anaesthesia in elderly patients. Acta Anaesthesiol Scand. 2012;56:382–7.

    Article  CAS  PubMed  Google Scholar 

  48. Austin TR. Ketamine hydrochloride: a potent analgesic. Br Med J. 1976;2:943.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Sadove MS, Shulman M, Hatano S, Fevold N. Analgesic effects of ketamine administered in subdissociative doses. Anesth Analg. 1971;50:452–7.

    CAS  PubMed  Google Scholar 

  50. Idvall J, Ahlgren I, Aronsen KR, Stenberg P. Ketamine infusions: pharmacokinetics and clinical effects. Br J Anaesth. 1979;51:1167–73.

    Article  CAS  PubMed  Google Scholar 

  51. Frey K, Sukhani R, Pawlowski J, Pappas AL, Mikat-Stevens M, Slogoff S. Propofol versus propofol-ketamine sedation for retrobulbar nerve block: comparison of sedation quality, intraocular pressure changes, and recovery profiles. Anesth Analg. 1999;89:317–21.

    CAS  PubMed  Google Scholar 

  52. Rosenberg MK, Raymond C, Bridge PD. Comparison of midazolam/ketamine with methohexital for sedation during peribulbar block. Anesth Analg. 1995;81:173–4.

    CAS  PubMed  Google Scholar 

  53. Kirkpatrick T, Cockshott ID, Douglas EJ, Nimmo WS. Pharmacokinetics of propofol (diprivan) in elderly patients. Br J Anaesth. 1988;60:146–50.

    Article  CAS  PubMed  Google Scholar 

  54. Schnider TW, Minto CF, Gambus PL, Andresen C, Goodale DB, Shafer SL, Youngs EJ. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88:1170–82.

    Article  CAS  PubMed  Google Scholar 

  55. Vuyk J, Oostwouder CJ, Vletter AA, Burm AG, Bovill JG. Gender differences in the pharmacokinetics of propofol in elderly patients during and after continuous infusion. Br J Anaesth. 2001;86:183–8.

    Article  CAS  PubMed  Google Scholar 

  56. Gragasin FS, Bourque SL, Davidge ST. Vascular aging and hemodynamic stability in the intraoperative period. Front Physiol. 2012;3:74.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Kazama T, Ikeda K, Morita K, Kikura M, Doi M, Ikeda T, Kurita T, Nakajima Y. Comparison of the effect-site k(eO)s of propofol for blood pressure and EEG bispectral index in elderly and younger patients. Anesthesiology. 1999;90:1517–27.

    Article  CAS  PubMed  Google Scholar 

  58. CPS: compendium of pharmaceuticals and specialties. 38th ed. Ottawa: Canadian Pharmacists Association; 2003. p. 1376–9.

    Google Scholar 

  59. Smith I, Monk TG, White PF, Ding Y. Propofol infusion during regional anesthesia: sedative, amnestic, and anxiolytic properties. Anesth Analg. 1994;79:313–9.

    CAS  PubMed  Google Scholar 

  60. Burton DA, Nicholson G, Hall GM. Anaesthesia in elderly patients with neurodegenerative disorders: special considerations. Drugs Aging. 2004;21:229–42.

    Article  CAS  PubMed  Google Scholar 

  61. Burm AG, Vermeulen NP, van Kleef JW, de Boer AG, Spierdijk J, Breimer DD. Pharmacokinetics of lignocaine and bupivacaine in surgical patients following epidural administration. Simultaneous investigation of absorption and disposition kinetics using stable isotopes. Clin Pharmacokinet. 1987;13:191–203.

    Article  CAS  PubMed  Google Scholar 

  62. Burm AG, van Kleef JW, Vermeulen NP, Olthof G, Breimer DD, Spierdijk J. Pharmacokinetics of lidocaine and bupivacaine following subarachnoid administration in surgical patients: simultaneous investigation of absorption and disposition kinetics using stable isotopes. Anesthesiology. 1988;69:584–92.

    Article  CAS  PubMed  Google Scholar 

  63. Burm AG. Clinical pharmacokinetics of epidural and spinal anaesthesia. Clin Pharmacokinet. 1989;16:283–311.

    Article  CAS  PubMed  Google Scholar 

  64. Tucker GT, Mather LE. Pharmacology of local anaesthetic agents. Pharmacokinetics of local anaesthetic agents. Br J Anaesth. 1975;47(Suppl):213–24.

    PubMed  Google Scholar 

  65. Tucker GT, Mather LE. Clinical pharmacokinetics of local anaesthetics. Clin Pharmacokinet. 1979;4:241–78.

    Article  CAS  PubMed  Google Scholar 

  66. Veering BT, Burm AG, Vletter AA, van den Hoeven RA, Spierdijk J. The effect of age on systemic absorption and systemic disposition of bupivacaine after subarachnoid administration. Anesthesiology. 1991;74:250–7.

    Article  CAS  PubMed  Google Scholar 

  67. Veering BT, Burm AG, Vletter AA, van den Heuvel RP, Onkenhout W, Spierdijk J. The effect of age on the systemic absorption, disposition and pharmacodynamics of bupivacaine after epidural administration. Clin Pharmacokinet. 1992;22:75–84.

    Article  CAS  PubMed  Google Scholar 

  68. Veering BT. The role of aging in local anesthesia. Pain Rev. 1999;6:167–73.

    Article  Google Scholar 

  69. Brandfonbrener M, Landowne M, Shock NW. Changes in cardiac output with age. Circulation. 1955;12:557–66.

    Article  CAS  PubMed  Google Scholar 

  70. Kuikka JT, Lansimies E. Effect of age on cardiac index, stroke index and left ventricular ejection fraction at rest and during exercise as studied by radiocardiography. Acta Physiol Scand. 1982;114:339–43.

    Article  CAS  PubMed  Google Scholar 

  71. Rodeheffer RJ, Gerstenblith G, Becker LC, Fleg JL, Weisfeldt ML, Lakatta EG. Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation. 1984;69:203–13.

    Article  CAS  PubMed  Google Scholar 

  72. Shafer SL. The pharmacology of anesthetic drugs in elderly patients. Anesthesiol Clin North America. 2000;18:1–29, v.

    Google Scholar 

  73. Sadean MR, Glass PS. Pharmacokinetics in the elderly. Best Pract Res Clin Anaesthesiol. 2003;17:191–205.

    Article  CAS  PubMed  Google Scholar 

  74. Denson D, Coyle D, Thompson G, Myers J. Alpha 1-acid glycoprotein and albumin in human serum bupivacaine binding. Clin Pharmacol Ther. 1984;35:409–15.

    Article  CAS  PubMed  Google Scholar 

  75. Piafsky KM, Knoppert D. Binding of local anesthetics to acid glycoprotein. Clin Res. 1978;26:836A.

    Google Scholar 

  76. Routledge PA, Barchowsky A, Bjornsson TD, Kitchell BB, Shand DG. Lidocaine plasma protein binding. Clin Pharmacol Ther. 1980;27:347–51.

    Article  CAS  PubMed  Google Scholar 

  77. Routledge PA, Shand DG, Barchowsky A, Wagner G, Stargel WW. Relationship between alpha 1-acid glycoprotein and lidocaine disposition in myocardial infarction. Clin Pharmacol Ther. 1981;30:154–7.

    Article  CAS  PubMed  Google Scholar 

  78. Shand DG: alpha 1-Acid glycoprotein and plasma lidocaine binding. Clin Pharmacokinet. 1984; 9 Suppl 1: 27–31

    Google Scholar 

  79. Veering BT, Burm AG, Souverijn JH, Serree JM, Spierdijk J. The effect of age on serum concentrations of albumin and alpha 1-acid glycoprotein. Br J Clin Pharmacol. 1990;29:201–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Wallace SM, Verbeeck RK. Plasma protein binding of drugs in the elderly. Clin Pharmacokinet. 1987;12:41–72.

    Article  CAS  PubMed  Google Scholar 

  81. Bowdle TA, Freund PR. Effects of age on local anesthetic agents. In: McLeskey CH, editor. Geriatric anesthesiology. Baltimore: Williams & Wilkins; 1997. p. 367–80.

    Google Scholar 

  82. Veering BT, Burm AG, van Kleef JW, Hennis PJ, Spierdijk J. Epidural anesthesia with bupivacaine: effects of age on neural blockade and pharmacokinetics. Anesth Analg. 1987;66:589–93.

    CAS  PubMed  Google Scholar 

  83. Abernethy DR, Greenblatt DJ. Impairment of lidocaine clearance in elderly male subjects. J Cardiovasc Pharmacol. 1983;5:1093–6.

    Article  CAS  PubMed  Google Scholar 

  84. Tsen LC, Arthur GR, Datta S, Hornstein MD, Bader AM. Estrogen-induced changes in protein binding of bupivacaine during in vitro fertilization. Anesthesiology. 1997;87:879–83.

    Article  CAS  PubMed  Google Scholar 

  85. Tsen LC, Tarshis J, Denson DD, Osathanondh R, Datta S, Bader AM. Measurements of maternal protein binding of bupivacaine throughout pregnancy. Anesth Analg. 1999;89:965–8.

    CAS  PubMed  Google Scholar 

  86. Vuyk J. Pharmacodynamics in the elderly. Best Pract Res Clin Anaesthesiol. 2003;17:207–18.

    Article  CAS  PubMed  Google Scholar 

  87. Bromage PR. Ageing and epidural dose requirements: segmental spread and predictability of epidural analgesia in youth and extreme age. Br J Anaesth. 1969;41:1016–22.

    Article  CAS  PubMed  Google Scholar 

  88. Park WY, Hagins FM, Rivat EL, Macnamara TE. Age and epidural dose response in adult men. Anesthesiology. 1982;56:318–20.

    Article  CAS  PubMed  Google Scholar 

  89. Mulroy MF. Modification of regional anesthetic techniques. In: McLeskey CH, editor. Geriatric anesthesiology. Baltimore: Williams & Wilkins; 1997. p. 367–80.

    Google Scholar 

  90. Minville V, Asehnoune K, Salau S, Bourdet B, Tissot B, Lubrano V, Fourcade O. The effects of spinal anesthesia on cerebral blood flow in the very elderly. Anesth Analg. 2009;108:1291–4.

    Article  PubMed  Google Scholar 

  91. Lee A, Kim SH, Hong JY, Hwang JH. Effect of anesthetic methods on cerebral oxygen saturation in elderly surgical patients: prospective, randomized, observational study. World J Surg. 2012;36:2328–34.

    Article  PubMed  Google Scholar 

  92. Finucane BT, Tsui BCH. Complications of brachial plexus anesthesia. In: Finucane BT, editor. Complications of regional anesthesia. 2nd ed. New York: Springer; 2007. p. 121–48.

    Chapter  Google Scholar 

  93. Finucane BT, Hammonds WD, Welch MB. Influence of age on vascular absorption of lidocaine from the epidural space. Anesth Analg. 1987;66:843–6.

    Article  CAS  PubMed  Google Scholar 

  94. Veering BT, Burm AG, Gladines MP, Spierdijk J. Age does not influence the serum protein binding of bupivacaine. Br J Clin Pharmacol. 1991;32:501–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Fukuda T, Kakiuchi Y, Miyabe M, Kihara S, Kohda Y, Toyooka H. Free lidocaine concentrations during continuous epidural anesthesia in geriatric patients. Reg Anesth Pain Med. 2003;28:215–20.

    Article  CAS  PubMed  Google Scholar 

  96. Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs. 2000;59:551–79.

    Article  CAS  PubMed  Google Scholar 

  97. Casati A, Santorsola R, Aldegheri G, Ravasi F, Fanelli G, Berti M, Fraschini G, Torri G. Intraoperative epidural anesthesia and postoperative analgesia with levobupivacaine for major orthopedic surgery: a double-blind, randomized comparison of racemic bupivacaine and ropivacaine. J Clin Anesth. 2003;15:126–31.

    Article  CAS  PubMed  Google Scholar 

  98. Urbanek B, Duma A, Kimberger O, Huber G, Marhofer P, Zimpfer M, Kapral S. Onset time, quality of blockade, and duration of three-in-one blocks with levobupivacaine and bupivacaine. Anesth Analg. 2003;97:888–92.

    Article  CAS  PubMed  Google Scholar 

  99. Cox B, Durieux ME, Marcus MA. Toxicity of local anaesthetics. Best Pract Res Clin Anaesthesiol. 2003;17:111–36.

    Article  CAS  PubMed  Google Scholar 

  100. Raj PP. Conduction blocks. In: Raj PP, editor. Textbook of regional anesthesia. London: Churchill Livingstone; 2002. p. 285–306.

    Google Scholar 

  101. Bromage PR. Epidural analgesia. Philadelphia: WB Saunders; 1978. p. 40–2.

    Google Scholar 

  102. Corbin KB, Gardner ED. Decrease in number of myelinated fibers in human spinal roots with age. Anat Rec. 1937;68:63–74.

    Article  Google Scholar 

  103. Dorfman LJ, Bosley TM. Age-related changes in peripheral and central nerve conduction in man. Neurology. 1979;29:38–44.

    Article  CAS  PubMed  Google Scholar 

  104. LaFratta CW, Canestrari R. A comparison of sensory and motor nerve conduction velocities as related to age. Arch Phys Med Rehabil. 1966;47:286–90.

    CAS  PubMed  Google Scholar 

  105. Pavicic Saric J, Vidjak V, Tomulic K, Zenko J. Effects of age on minimum effective volume of local anesthetic for ultrasound-guided supraclavicular brachial plexus block. Acta Anaesthesiol Scand. 2013;57:761–6.

    Article  PubMed  Google Scholar 

  106. Paqueron X, Boccara G, Bendahou M, Coriat P, Riou B. Brachial plexus nerve block exhibits prolonged duration in the elderly. Anesthesiology. 2002;97:1245–9.

    Article  PubMed  Google Scholar 

  107. Aslim E, Akay TH, Candan S, Ozkan S, Akpek E, Gultekin B. Regional anesthesia in elderly patients undergoing carotid surgery: report of a case series. Semin Cardiothorac Vasc Anesth. 2008;12:29–32.

    Article  PubMed  Google Scholar 

  108. Leoni A, Magrin S, Mascotto G, Rigamonti A, Gallioli G, Muzzolon F, Fanelli G, Casati A. Cervical plexus anesthesia for carotid endarterectomy: comparison of ropivacaine and mepivacaine. Can J Anaesth. 2000;47:185–7.

    Article  CAS  PubMed  Google Scholar 

  109. Ganapathy S, Wasserman RA, Watson JT, Bennett J, Armstrong KP, Stockall CA, Chess DG, MacDonald C. Modified continuous femoral three-in-one block for postoperative pain after total knee arthroplasty. Anesth Analg. 1999;89:1197–202.

    Article  CAS  PubMed  Google Scholar 

  110. Snoeck MM, Vree TB, Gielen MJ, Lagerwert AJ. Steady state bupivacaine plasma concentrations and safety of a femoral “3-in-1” nerve block with bupivacaine in patients over 80 years of age. Int J Clin Pharmacol Ther. 2003;41:107–13.

    Article  CAS  PubMed  Google Scholar 

  111. Liu SS, Salinas FV. Continuous plexus and peripheral nerve blocks for postoperative analgesia. Anesth Analg. 2003;96:263–72.

    PubMed  Google Scholar 

  112. Cusack B, O’Malley K, Lavan J, Noel J, Kelly JG. Protein binding and disposition of lignocaine in the elderly. Eur J Clin Pharmacol. 1985;29:323–9.

    Article  CAS  PubMed  Google Scholar 

  113. Nation RL, Triggs EJ, Selig M. Lignocaine kinetics in cardiac patients and aged subjects. Br J Clin Pharmacol. 1977;4:439–48.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Simon MJ, Veering BT, Stienstra R, van Kleef JW, Burm AG. Effect of age on the clinical profile and systemic absorption and disposition of levobupivacaine after epidural administration. Br J Anaesth. 2004;93:512–20.

    Article  CAS  PubMed  Google Scholar 

  115. Dauphin A, Raymer KE, Stanton EB, Fuller HD. Comparison of general anesthesia with and without lumbar epidural for total hip arthroplasty: effects of epidural block on hip arthroplasty. J Clin Anesth. 1997;9:200–3.

    Article  CAS  PubMed  Google Scholar 

  116. Tuman KJ, McCarthy RJ, March RJ, DeLaria GA, Patel RV, Ivankovich AD. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg. 1991;73:696–704.

    Article  CAS  PubMed  Google Scholar 

  117. Mann C, Pouzeratte Y, Boccara G, Peccoux C, Vergne C, Brunat G, Domergue J, Millat B, Colson P. Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery. Anesthesiology. 2000;92:433–41.

    Article  CAS  PubMed  Google Scholar 

  118. Rundshagen I, Kochs E, Standl T, Schnabel K. Schulte am EJ: Subarachnoid and intravenous PCA versus bolus administration for postoperative pain relief in orthopaedic patients. Acta Anaesthesiol Scand. 1998;42:1215–21.

    Article  CAS  PubMed  Google Scholar 

  119. Shir Y, Raja SN, Frank SM. The effect of epidural versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing radical prostatectomy. Anesthesiology. 1994;80:49–56.

    Article  CAS  PubMed  Google Scholar 

  120. Wulf H, Biscoping J, Beland B, Bachmann-Mennenga B, Motsch J. Ropivacaine epidural anesthesia and analgesia versus general anesthesia and intravenous patient-controlled analgesia with morphine in the perioperative management of hip replacement. Ropivacaine hip replacement multicenter study group. Anesth Analg. 1999;89:111–6.

    CAS  PubMed  Google Scholar 

  121. Hirabayashi Y, Shimizu R, Matsuda I, Inoue S. Effect of extradural compliance and resistance on spread of extradural analgesia. Br J Anaesth. 1990;65:508–13.

    Article  CAS  PubMed  Google Scholar 

  122. Nishimura N, Kitahara T, Kusakabe T. The spread of lidocaine and I-131 solution in the epidural space. Anesthesiology. 1959;20:785–8.

    Article  CAS  PubMed  Google Scholar 

  123. Bromage PR. Exaggerated spread of epidural analgesia in arteriosclerotic patients. Dosage in relation to biological and chronological ageing. Br Med J. 1962;2:1634–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  124. Shantha TR, Evans JA. The relationship of epidural anesthesia to neural membranes and arachnoid villi. Anesthesiology. 1972;37:543–57.

    Article  CAS  PubMed  Google Scholar 

  125. Sear JW, Higham H. Issues in the perioperative management of the elderly patient with cardiovascular disease. Drugs Aging. 2002;19:429–51.

    Article  PubMed  Google Scholar 

  126. Faccenda KA, Finucane BT. Complications of regional anaesthesia incidence and prevention. Drug Saf. 2001;24:413–42.

    Article  CAS  PubMed  Google Scholar 

  127. Yuen EC, Layzer RB, Weitz SR, Olney RK. Neurologic complications of lumbar epidural anesthesia and analgesia. Neurology. 1995;45:1795–801.

    Article  CAS  PubMed  Google Scholar 

  128. Li Y, Zhu S, Bao F, Xu J, Yan X, Jin X. The effects of age on the median effective concentration of ropivacaine for motor blockade after epidural anesthesia with ropivacaine. Anesth Analg. 2006;102:1847–50.

    Article  CAS  PubMed  Google Scholar 

  129. Park EY, Kil HK, Park WS, Lee NH, Hong JY. Effect of epidural saline washout on regression of sensory and motor block after epidural anaesthesia with 2 % lidocaine and fentanyl in elderly patients. Anaesthesia. 2009;64:273–6.

    Article  CAS  PubMed  Google Scholar 

  130. Reisli R, Celik J, Tuncer S, Yosunkaya A, Otelcioglu S. Anaesthetic and haemodynamic effects of continuous spinal versus continuous epidural anaesthesia with prilocaine. Eur J Anaesthesiol. 2003;20:26–30.

    Article  CAS  PubMed  Google Scholar 

  131. Crescenzi G, Landoni G, Monaco F, Bignami E, De LM, Frau G, Rosica C, Zangrillo A. Epidural anesthesia in elderly patients undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2009;23:807–12.

    Article  PubMed  Google Scholar 

  132. Jakobsen CJ, Bhavsar R, Nielsen DV, Ryhammer PK, Sloth E, Greisen J. High thoracic epidural analgesia in cardiac surgery. Part 1—high thoracic epidural analgesia improves cardiac performance in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2012;26:1039–47.

    Article  PubMed  Google Scholar 

  133. Stevens RA. Neuraxial blocks. In: Brown DL, editor. Regional anesthesia and analgesia. Philadelphia: WB Saunders; 1996. p. 319–56.

    Google Scholar 

  134. Ward RJ, Bonica JJ, Freund FG, Akamatsu T, Danziger F, Englesson S. Epidural and subarachnoid anesthesia. Cardiovascular and respiratory effects. JAMA. 1965;191:275–8.

    Article  CAS  PubMed  Google Scholar 

  135. Tomoda MK, Ueda W, Hirakawa M. Hemodynamic effect of epidurally administered epinephrine in middle-aged and elderly patients. Acta Anaesthesiol Scand. 1989;33:647–51.

    Article  CAS  PubMed  Google Scholar 

  136. Vestal RE, Wood AJ, Shand DG. Reduced beta-adrenoceptor sensitivity in the elderly. Clin Pharmacol Ther. 1979;26:181–6.

    Article  CAS  PubMed  Google Scholar 

  137. Gustafsson LL, Schildt B, Jacobsen K. Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. Br J Anaesth. 1982;81:86–93.

    Google Scholar 

  138. Ready LB, Chadwick HS, Ross B. Age predicts effective epidural morphine dose after abdominal hysterectomy. Anesth Analg. 1987;66:1215–8.

    Article  CAS  PubMed  Google Scholar 

  139. Kampe S, Weigand C, Kaufmann J, Klimek M, Konig DP, Lynch J. Postoperative analgesia with no motor block by continuous epidural infusion of ropivacaine 0.1 % and sufentanil after total hip replacement. Anesth Analg. 1999;89:395–8.

    CAS  PubMed  Google Scholar 

  140. Kampe S, Randebrock G, Kiencke P, Hunseler U, Cranfield K, Konig DP, Diefenbach C. Comparison of continuous epidural infusion of ropivacaine and sufentanil with intravenous patient-controlled analgesia after total hip replacement. Anaesthesia. 2001;56:1189–93.

    Article  CAS  PubMed  Google Scholar 

  141. Kampe S, Kiencke P, Delis A, Auweiler M, Konig DP, Kasper SM. The continuous epidural infusion of ropivacaine 0.1 % with 0.5 microg x mL(−1) sufentanil provides effective postoperative analgesia after total hip replacement: a pilot study. Can J Anaesth. 2003;50:580–5.

    Article  PubMed  Google Scholar 

  142. Berti M, Fanelli G, Casati A, Lugani D, Aldegheri G, Torri G. Comparison between epidural infusion of fentanyl/bupivacaine and morphine/bupivacaine after orthopaedic surgery. Can J Anaesth. 1998;45:545–50.

    Article  CAS  PubMed  Google Scholar 

  143. El Shobary HM, Sonbul ZM, Schricker TP. Epidural ketamine for postoperative analgesia in the elderly. Middle East J Anaesthesiol. 2008;19:1369–78.

    PubMed  Google Scholar 

  144. Dohi S, Naito H, Takahashi T. Age-related changes in blood pressure and duration of motor block in spinal anesthesia. Anesthesiology. 1979;50:319–23.

    Article  CAS  PubMed  Google Scholar 

  145. Park WY, Balingit PE, Macnamara TE. Effects of patient age, pH of cerebrospinal fluid, and vasopressors on onset and duration of spinal anesthesia. Anesth Analg. 1975;54:455–8.

    Article  CAS  PubMed  Google Scholar 

  146. Tuominen M, Pitkanen M, Doepel M, Rosenberg PH. Spinal anaesthesia with hyperbaric tetracaine: effect of age and body mass. Acta Anaesthesiol Scand. 1987;31:474–8.

    Article  CAS  PubMed  Google Scholar 

  147. Pitkanen M, Haapaniemi L, Tuominen M, Rosenberg PH. Influence of age on spinal anaesthesia with isobaric 0.5 % bupivacaine. Br J Anaesth. 1984;56:279–84.

    Article  CAS  PubMed  Google Scholar 

  148. Racle JP, Benkhadra A, Poy JY, Gleizal B. Spinal analgesia with hyperbaric bupivacaine: influence of age. Br J Anaesth. 1988;60:508–14.

    Article  CAS  PubMed  Google Scholar 

  149. Veering BT, Burm AG, van Kleef JW, Hennis PJ, Spierdijk J. Spinal anesthesia with glucose-free bupivacaine: effects of age on neural blockade and pharmacokinetics. Anesth Analg. 1987;66:965–70.

    CAS  PubMed  Google Scholar 

  150. Veering BT, Burm AG, Spierdijk J. Spinal anaesthesia with hyperbaric bupivacaine. Effects of age on neural blockade and pharmacokinetics. Br J Anaesth. 1988;60:187–94.

    Article  CAS  PubMed  Google Scholar 

  151. Messina A, Frassanito L, Colombo D, Vergari A, Draisci G, Della CF, Antonelli M. Hemodynamic changes associated with spinal and general anesthesia for hip fracture surgery in severe ASA III elderly population: a pilot trial. Minerva Anestesiol. 2013;79:1021–9.

    CAS  PubMed  Google Scholar 

  152. Beaupre LA, Jones CA, Saunders LD, Johnston DW, Buckingham J, Majumdar SR. Best practices for elderly hip fracture patients. A systematic overview of the evidence. J Gen Intern Med. 2005;20:1019–25.

    Article  PubMed  PubMed Central  Google Scholar 

  153. Nightingale PJ, Marstrand T. Subarachnoid anaesthesia with bupivacaine for orthopaedic procedures in the elderly. Br J Anaesth. 1981;53:369–71.

    Article  CAS  PubMed  Google Scholar 

  154. Meyhoff CS, Hesselbjerg L, Koscielniak-Nielsen Z, Rasmussen LS. Biphasic cardiac output changes during onset of spinal anaesthesia in elderly patients. Eur J Anaesthesiol. 2007;24:770–5.

    Article  CAS  PubMed  Google Scholar 

  155. Kannan S. Ten milligrams intrathecal bupivacaine is too high for spinal anesthesia for hip surgery in the geriatric population. Anesthesiology. 2000;93:1365.

    Article  CAS  PubMed  Google Scholar 

  156. Biboulet P, Deschodt J, Aubas P, Vacher E, Chauvet P, d’Athis F. Continuous spinal anesthesia: does low-dose plain or hyperbaric bupivacaine allow the performance of hip surgery in the elderly? Reg Anesth. 1993;18:170–5.

    CAS  PubMed  Google Scholar 

  157. Kararmaz A, Kaya S, Turhanoglu S, Ozyilmaz MA. Low-dose bupivacaine-fentanyl spinal anaesthesia for transurethral prostatectomy. Anaesthesia. 2003;58:526–30.

    Article  CAS  PubMed  Google Scholar 

  158. Hwang J, Min S, Kim C, Gil N, Kim E, Huh J. Prophylactic glycopyrrolate reduces hypotensive responses in elderly patients during spinal anesthesia: a randomized controlled trial. Can J Anaesth. 2014;61:32–8.

    Article  PubMed  Google Scholar 

  159. McNamee DA, McClelland AM, Scott S, Milligan KR, Westman L, Gustafsson U. Spinal anaesthesia: comparison of plain ropivacaine 5 mg ml(−1) with bupivacaine 5 mg ml(−1) for major orthopaedic surgery. Br J Anaesth. 2002;89:702–6.

    Article  CAS  PubMed  Google Scholar 

  160. McNamee DA, Parks L, McClelland AM, Scott S, Milligan KR, Ahlen K, Gustafsson U. Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml(-1) and 10 mg ml(-1) solutions. Br J Anaesth. 2001;87:743–7.

    Article  CAS  PubMed  Google Scholar 

  161. Malinovsky JM, Charles F, Kick O, Lepage JY, Malinge M, Cozian A, Bouchot O, Pinaud M. Intrathecal anesthesia: ropivacaine versus bupivacaine. Anesth Analg. 2000;91:1457–60.

    Article  CAS  PubMed  Google Scholar 

  162. van Kleef JW, Veering BT, Burm AG. Spinal anesthesia with ropivacaine: a double-blind study on the efficacy and safety of 0.5 % and 0.75 % solutions in patients undergoing minor lower limb surgery. Anesth Analg. 1994;78:1125–30.

    PubMed  Google Scholar 

  163. Whiteside JB, Burke D, Wildsmith JA. Spinal anaesthesia with ropivacaine 5 mg ml(-1) in glucose 10 mg ml(-1) or 50 mg ml(-1). Br J Anaesth. 2001;86:241–4.

    Article  CAS  PubMed  Google Scholar 

  164. Chen TY, Tseng CC, Wang LK, Tsai TY, Chen BS, Chang CL. The clinical use of small-dose tetracaine spinal anesthesia for transurethral prostatectomy. Anesth Analg. 2001;92:1020–3.

    Article  CAS  PubMed  Google Scholar 

  165. Salinas FV, Liu SS. Spinal anaesthesia: local anaesthetics and adjuncts in the ambulatory setting. Best Pract Res Clin Anaesthesiol. 2002;16:195–210.

    Article  CAS  PubMed  Google Scholar 

  166. Hampl KF, Schneider MC, Pargger H, Gut J, Drewe J, Drasner K. A similar incidence of transient neurologic symptoms after spinal anesthesia with 2 % and 5 % lidocaine. Anesth Analg. 1996;83:1051–4.

    Article  CAS  PubMed  Google Scholar 

  167. Hampl KF, Heinzmann-Wiedmer S, Luginbuehl I, Harms C, Seeberger M, Schneider MC, Drasner K. Transient neurologic symptoms after spinal anesthesia: a lower incidence with prilocaine and bupivacaine than with lidocaine. Anesthesiology. 1998;88:629–33.

    Article  CAS  PubMed  Google Scholar 

  168. Liguori GA, Zayas VM, Chisholm MF. Transient neurologic symptoms after spinal anesthesia with mepivacaine and lidocaine. Anesthesiology. 1998;88:619–23.

    Article  CAS  PubMed  Google Scholar 

  169. Martinez-Bourio R, Arzuaga M, Quintana JM, Aguilera L, Aguirre J, Saez-Eguilaz JL, Arizaga A. Incidence of transient neurologic symptoms after hyperbaric subarachnoid anesthesia with 5 % lidocaine and 5 % prilocaine. Anesthesiology. 1998;88:624–8.

    Article  CAS  PubMed  Google Scholar 

  170. Pollock JE, Neal JM, Stephenson CA, Wiley CE. Prospective study of the incidence of transient radicular irritation in patients undergoing spinal anesthesia. Anesthesiology. 1996;84:1361–7.

    Article  CAS  PubMed  Google Scholar 

  171. Pollock JE, Liu SS, Neal JM, Stephenson CA. Dilution of spinal lidocaine does not alter the incidence of transient neurologic symptoms. Anesthesiology. 1999;90:445–50.

    Article  CAS  PubMed  Google Scholar 

  172. Carpenter RL. Hyperbaric lidocaine spinal anesthesia: do we need an alternative? Anesth Analg. 1995;81:1125–8.

    CAS  PubMed  Google Scholar 

  173. Douglas MJ. Neurotoxicity of lidocaine—does it exist? Can J Anaesth. 1995;42:181–5.

    Article  CAS  PubMed  Google Scholar 

  174. Favarel-Garrigues JF, Sztark F, Petitjean ME, Thicoipe M, Lassie P, Dabadie P. Hemodynamic effects of spinal anesthesia in the elderly: single dose versus titration through a catheter. Anesth Analg. 1996;82:312–6.

    CAS  PubMed  Google Scholar 

  175. Labaille T, Benhamou D, Westermann J. Hemodynamic effects of continuous spinal anesthesia: a comparative study between low and high doses of bupivacaine. Reg Anesth. 1992;17:193–6.

    CAS  PubMed  Google Scholar 

  176. Minville V, Fourcade O, Grousset D, Chassery C, Nguyen L, Asehnoune K, Colombani A, Goulmamine L, Samii K. Spinal anesthesia using single injection small-dose bupivacaine versus continuous catheter injection techniques for surgical repair of hip fracture in elderly patients. Anesth Analg. 2006;102:1559–63.

    Article  CAS  PubMed  Google Scholar 

  177. Biboulet P, Capdevila X, Aubas P, Rubenovitch J, Deschodt J, d’Athis F. Causes and prediction of maldistribution during continuous spinal anesthesia with isobaric or hyperbaric bupivacaine. Anesthesiology. 1998;88:1487–94.

    Article  CAS  PubMed  Google Scholar 

  178. Boico O, Bonnet F, Mazoit JX. Effects of epinephrine and clonidine on plasma concentrations of spinal bupivacaine. Acta Anaesthesiol Scand. 1992;36:684–8.

    Article  CAS  PubMed  Google Scholar 

  179. Fournier R, Van Gessel E, Weber A, Gamulin Z. Epinephrine and clonidine do not improve intrathecal sufentanil analgesia after total hip replacement. Br J Anaesth. 2002;89:562–6.

    Article  CAS  PubMed  Google Scholar 

  180. Racle JP, Benkhadra A, Poy JY, Gleizal B. Prolongation of isobaric bupivacaine spinal anesthesia with epinephrine and clonidine for hip surgery in the elderly. Anesth Analg. 1987;66:442–6.

    Article  CAS  PubMed  Google Scholar 

  181. Racle JP, Benkhadra A, Poy JY, Gleizal B. Effect of increasing amounts of epinephrine during isobaric bupivacaine spinal anesthesia in elderly patients. Anesth Analg. 1987;66:882–6.

    CAS  PubMed  Google Scholar 

  182. Dobrydnjov I, Samarutel J. Enhancement of intrathecal lidocaine by addition of local and systemic clonidine. Acta Anaesthesiol Scand. 1999;43:556–62.

    Article  CAS  PubMed  Google Scholar 

  183. Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology. 2000;92:6–10.

    Article  CAS  PubMed  Google Scholar 

  184. Olofsson C, Nygards EB, Bjersten AB, Hessling A. Low-dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients. Acta Anaesthesiol Scand. 2004;48:1240–4.

    Article  CAS  PubMed  Google Scholar 

  185. Slappendel R, Weber EW, Dirksen R, Gielen MJ, van LJ. Optimization of the dose of intrathecal morphine in total hip surgery: a dose-finding study. Anesth Analg. 1999;88:822–6.

    Article  CAS  PubMed  Google Scholar 

  186. Togal T, Demirbilek S, Koroglu A, Yapici E, Ersoy O. Effects of S(+) ketamine added to bupivacaine for spinal anaesthesia for prostate surgery in elderly patients. Eur J Anaesthesiol. 2004;21:193–7.

    Article  CAS  PubMed  Google Scholar 

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Gragasin, F.S., Tsui, B.C.H. (2017). Local and Regional Anesthesia in the Elderly. In: Finucane, B., Tsui, B. (eds) Complications of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-49386-2_17

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