[PP02: 05] IMPACT OF CARDIOVASCULAR COMORBIDITY ON ANAESTHESIA MANAGEMENT IN ELDERLY

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Abstract

Objective:

Increase the number of elderly patients is a serious problem for anesthesiology. They are characterized by a severe of comorbidities, especially cardiovascular disease. This increases the number of perioperative complications. Endothelin-1 determines endothelial function and is one of the marker cardiovascular disease. The goal of study was evaluate the structure of comorbidity and endothelial function in elderly in perioperative non-cardiac surgery.

Design and method:

We prospective examined 200 patients aged 60 to 82 years for abdominal surgery. 55 patients were divided into 2 groups according to gender - a subgroup of women (n = 32) and men (n = 23). There were representative of the gender, age, ASA, BMI. Comorbidities were accounted for systems; identification of the prevailing pathology; identifying the causes of mortality. Patients with cardiovascular disease managed in accordance with ESC Guidelines (2014) and received treatment. Endothelin-1 in EDTA-plasma determined by enzyme immunoassay (set Biomedica). Data are presented as M ± m, significant value of p < 0,05.

Results:

The severity of the patients corresponded to 58% of ASAII, 42% - ASAIII. Coronary artery disease and cardiosclerosis occurred in 30,6 and 58,4% patients. 42% of patients had multiple comorbidity. The level of Endothelin-1 in all patients was increased by 45% compared to the reference values up to 0,556 ± 0,02 fmol/ml. Increased levels of marker and 1 day after surgery. In a subgroup of men it was higher (0,698 ± 0,03 and 0,583 ± 0,9 fmol/ml, respectively). By the 5 day the level of Endothelin-1 in both groups significantly decreased to preoperative baseline to 0,582 ± 0,013 fmol/ml, but did not reach the reference values.

Conclusions:

Comorbidity was found in 94% of elderly. The most frequently ones was cardiovascular (90%). In 42% of cases there is a multiple comorbidity. Prevalent cause of death was progression of chronic cardiovascular disease, development of acute cardiovascular disease. Elderly showed a significant increase in the level of Endothelin-1, indicating the presence of endothelial dysfunction. By the 5 day of the postop signs of endothelial dysfunction were reduced but not disappear. Based on these data we can make the right choice of anesthesia and perioperative care.

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