Author(s)

Sharmin Ara Begum^1*, A. K. M. Akhtaruzzaman², Dilip Kumar Bhowmick², Debabrata Banik², Md. Afzalur Rahman³, A. K. M. Shahidur Rahman⁴, Md. Saydur Rahman⁵, Khandoker Moynul Hasan⁶, Mohammad Kamrul Ahsan⁷, Md. Imrul Islam⁸, Muhammad Shamsul Arefin³, Tahmidul Islam⁹

¹Department of Anaesthesiology, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh.
²Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
³Department of Neuro-Anaesthesia, National Institute of Neurosciences and Hospital (NINS), Sher-e-Bangla Nagar, Agargaon, Dhaka, Bangladesh.
⁴Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
⁵Department of Anaesthesia, Asgor Ali Hospital, Dhaka, Bangladesh.
⁶Department of Pediatric Surgery, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh.
⁷Holy Family Red Crescent Medical College Hospital (HFRCMCH), Dhaka, Bangladesh.
⁸Department of Anaesthesiology and Intensive Care Unit (ICU), Rajshahi Medical College Hospital (RMCH), Rajshahi, Bangladesh.
⁹Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups; 35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO₂ (EtCO₂), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p < 0.001). Mean RR, SpO2, EtCO₂, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe; produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.

Combined Spinal Epidural Anaesthesia (CSEA), Geriatric Patients, Spinal Anaesthesia (SA)

Begum, S. , Akhtaruzzaman, A. , Bhowmick, D. , Banik, D. , Rahman, M. , Rahman, A. , Rahman, M. , Hasan, K. , Ahsan, M. , Islam, M. , Arefin, M. and Islam, T. (2020) Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery. Journal of Biosciences and Medicines, 8, 132-147. doi: 10.4236/jbm.2020.810012.