노인마취의 임상적 고찰

In contrast to younger patients, old peoples frequently manifest more than one pathologic process, mainly degenerative diseases and neoplasia. Nearly all have some degree of arteri-osclerosis, even if this is not clinically diagnosed, and many have associated chronic cardiac, renal, hepatic, or pulmonary disease. The surgein and the anesthesiologist must see that their clincial decisions are tied to a physiologic understanding dased on exact quantification of the specific hemodynamic, respira-tory, renal, and metabolic factors which may play a decisice role in influencing the final outcome to a major operative procedure. From May 1972 to Dec 1980, the Department od anenthesiology, Hanyang University, Col-lege were analyzed clinically according to age, sex, department, phsical status, anesthetic technique and agent, anesthesia time, length of admission, laboratoty studise (chest X-ray, EKGm arterial blood gas), and postoprative complications (mortality and causes og death) the results are as follows: 1) Out of 25.857 anesthetized patients 517(2.0%) were over 64 years of age and 290 were males(56.1%) and 227 females(43.9%). 2) In the surgical group, 246 cases(47.6%) were from general surgery; 81 cases (15.7%), orthopedic surgry; 78 cases(15.1%), urology; and 67cases(12.9%), neurosugery respectively. 3) In the classification of physical status, 33 cases(6.4%) were class 1, 269 cases(52.0%) class 2, 181 cases(35.0%) class 3, 28 cases(5.4%) class 4, and 6 cases(1.2%) class 5, Emerg-ency cases were 137 cases(26.5%) and 380 cases(73.5%) eere elevtive. 4) Concernign premedication-150 cases(29.0%) were premedicated with atropine sulfate plus Valium and 93 cases had no premedication. 5) There were 425 cases of general anesthesia(82.2%) and 92 cases of regional anesthesia(17.8%). The major anesthetic was halothene, 362 cases(70.0%). The rechnic in 419 cases(81.0%) was circle type with endotracheal intubation. Anesthesia duration was within 1 hour for 70 cases(13.5%), within 2 hours for 158 cases(30.0%), and within 3 hours in 144 cases(27.9%). 6) Preoperative laboratory findings were as follows: The chest X-ray suggested that 199 cases(45.9%) were within nomal limits, 56 cases (12.9%) had hypertensive heart disease, 56 cases(12.9%) had pulmonary tuberculosis, and 38 cases(5.1%) had senile lung fibrosis. The EKG, which ws done on 85% of the patients, ravealed that 193 cases(44.0%) were within narmal limits, 61 cases(13.9%) showed left ventricual hypertrophy, and 38 cas