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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 February;40(1):153-6

lingua: Inglese

Oesophagogastrectomy in the eld­er­ly ­high ­risk ­patients: role of effec­tive region­al anal­ge­sia and ear­ly mobil­isa­tion

Sabanathan S., Shah R., Tsiamis A., Richardson J.

From the Department of Thoracic Surgery Bradford Royal Infirmary Duckworth Lane, Bradford, UK


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Background. Oesophagogastrectomy is the ­best avail­able treat­ment for ­patients ­with car­ci­no­ma of the oesoph­a­gus or car­dia. However, sur­gi­cal resec­tion may ­lead to ­increased mor­tal­ity, mor­bid­ity and long­er hos­pi­tal ­stays in eld­er­ly (aged ­over 70 ­years) ­high ­risk ­patients.
Methods. To ­assess the ­impact of bal­anced pre-emp­tive and post­op­er­a­tive anal­ge­sia com­bined ­with ear­ly mobil­isa­tion in eld­er­ly ­patients under­go­ing oeso­phag­o­gas­trec­to­my we con­sec­u­tive­ly stud­ied 52 ­patients (30 ­male, 22 ­female) of 75±4.2 ­years of age (­mean±SD). Pre-emp­tive anal­ge­sia was by pre-inci­sion­al per­cut­ane­ous par­a­ver­te­bral ­block com­bined ­with an opi­ate and a non-ster­oid­al ­anti-inflam­ma­to­ry ­drug (­NSAID) pre­med­i­ca­tion. Postoperative main­te­nance anal­ge­sia was by ­NSAID and con­tin­u­ous extra­pleu­ral inter­cos­tal ­nerve ­block. Following sur­gery all but ­three ­patients ­were ­returned to the ­ward.
Results. The hos­pi­tal mor­tal­ity ­rate was 7.6%. Morbidity ­caused by car­di­o­vas­cu­lar (27%), res­pir­a­to­ry (23%) and cereb­ro­vas­cu­lar (19%) com­pli­ca­tions ­occurred in 19 ­patients, ­with two ­patients requir­ing ven­til­a­to­ry sup­port. The ­mean hos­pi­tal ­stay for the sur­vi­vors was 10 ­days (­range 8 to 30 ­days). All the sur­vi­vors had ­their swal­low­ing ­restored to nor­mal and ­returned to ­their accus­tomed envi­ronment.
Conclusions. These ­data sug­gests ­that sur­gi­cal treat­ment can be ­achieved in the eld­er­ly ­high ­risk ­patients ­with accept­able mor­tal­ity and mor­bid­ity. This is ­achieved by ear­ly mobil­isa­tion ena­bled by bal­anced pre-emp­tive and post­op­er­a­tive anal­ge­sia.

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