Perioperative Anesthetic Management For Elderly Cases With Hip Fractures: A Retrospective Study And Literature Review

Objective In this retrospective study,by reviewing and analyzing the perioperative anesthetic management of 120 cases of elderly patients with hip fractures,we tried evaluate the impacts of different anesthetic strategies on intraoperative hemodynamics or postoperative complications,therefore to provide basic evidences for clinical anesthesia with safety and efficacy.Method Retrospective study on medical records from the year scope of 2011 to 2015 for 120 cases of elderly hip fractures in our hospital,including general condition,anesthesia approach,anesthetic efficacy,perioperative hemodynamic changes,such as blood pressure and heart rate,incidence of pulmonary infection,thromboembolism,cardiac failure during their hospitalization,postoperative adverse events,for example postoperative cognitive dysfunction,and their prognosis.Processed with SPSS17.0edition,numeric data were analyzed by one-way ANOVA or Repeated Measures ANOVA,while qualitative data were analyzed by non-parametric test or Chi-square test when appropriate.Result Patients were categories by anesthetic approach and all among the three groups smoothly completed the surgery.As for the anesthetic efficacy,both of the general anesthesia group and group of spinal anesthesia with epidural anesthesia in combined,are superior to group with lumbar plexus and sciatic nerve block(P<0.05).During the intraoperative period,each group has detected apparent decrease in blood pressure(P<0.05),however no remarkable differences with transient hypotention between groups(P>0.05).Even no obvious differences in the incidence of severe hypotention(P>0.05),let alone no significant changes to their heart rate and pulse oxymetry(P>0.05).Moreover,chance are high for groups received general anesthesia to admission to intensive care unit or acquire postoperative pulmonary infection(P<0.05).As to postoperative cognitive dysfunction,thrombosis,heart failure and other complications,no significant difference were found among the three groups(P>0.05).And none hospital death.Conclusion In all,we recommended that,for elderly patients with hip fracture,spinal anesthesia with epidural anesthesia in combined,be more profitable strategy for perioperative anesthetic management,for its better efficacy than that of the lumbar plexus block with sciatic nerve block in combined,and less accurence to adverse events than general anesthesia.