November 2000
Volume 64 |
Number 11
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| Letters
To The Editor |
Geriatric Anesthesia Is Paying Attention to Total Patient
In regard to the May 2000 NEWSLETTER article by Jeffrey
H. Silverstein, M.D., on functional outcomes in elderly patients,
the decrement in functional status in elderly patients after general
anesthesia is not something new to any experienced anesthesiologist
who pays attention to how these patients do in the postoperative
period. For example, many claim that studies have failed to show
a morbidity benefit to regional anesthesia compared to general
anesthesia; and in terms of strict cardiovascular and even respiratory
outcomes, it may perhaps be difficult to show such a benefit.
However, it is precisely the functional outcome "the totality
or final end result of how the patient has really done" that
concerns me most when I undertake to provide anesthesia for, say,
a frail 80-year-old patient with a preoperative baseline SpO2
of 90 percent on room air undergoing a colectomy. After a regional
anesthetic, these patients will most commonly be returned to their
preoperative functional status immediately at the end of surgery
(in terms of mental function, SpO2 on room air and at least upper
extremity use). On the other hand, it may take days and sometimes
longer to recover to this level after general anesthesia in the
very elderly.
Why bother to put in the effort to conduct such an anesthetic?
It is the difference in functional outcome that I am ultimately
targeting. I want my patients to look and feel like they never
had surgery at all. With today's agents, this can sometimes be
accomplished in young patients even with general anesthesia; we
are not even remotely there with elderly folks.
The idea of a new category of "geriatric" anesthesia
seems to me just an awakening of technician anesthesiologists
(and some surgeons) who previously were not paying a whole lot
of attention to the totality of their patients’ well-being. With
the recent focus on functional outcomes, perhaps those who have
failed to see this most important benefit of regional anesthesia
may now gain some insight. They will still have to care enough,
though, to put in the effort.
Leo I. Stemp, M.D.
State College, Pennsylvania
A Fairy Tale Ending? Not in the Real World
Thanks for your "Ventilations" in the June 2000 NEWSLETTER.
Perhaps needless to say, I do agree with you. Interesting that
you should use the deus ex machina notion in your analysis of
anesthesiology. I have always found it fascinating that it seems
to be a particularly "human" thing to blame others for
problems and look for supernatural solutions to come from nowhere.
I am quite tired of hearing things like, "Just wait till
Dr. X’ gets here. He will solve our problems."
What is particularly astonishing to me is that anesthesiologists
appear to be willing to accept increased risk and to compromise
care in an effort to maintain cash flow. These "golden handcuffs"
will undoubtedly result in "divine legislation" that
will kill the integrity of the specialty in short order. I agree
that "the solution is among us." Yes, anesthesiologists
collectively have the power to solve the problem quickly. Furthermore,
I would suggest that the power of the solution rests upon uncompromising
professional integrity and our value as advocates for quality
patient care. This must continue to be demonstrated in direct
patient care, teaching, research and administrative circles, and
we must support each other firmly in the process.
I thank you for sharing your vision, and I thank ASA for giving
you the editorial position you hold.
Michael F. Mascia, M.D.
New Orleans, Louisiana
The views and opinions expressed in the "Letters
to the Editor" are those of the authors and do not necessarily
reflect the views of ASA or the NEWSLETTER Editorial Board.
Letters submitted for consideration should not exceed 300 words
in length. The Editor has the authority to accept or reject any
letter submitted for publication. Personal correspondence to the
Editor by letter or e-mail must be clearly indicated as "Not
for Publication" by the sender. Letters must be signed (although
name may be withheld on request) and are subject to editing and
abridgment.
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