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Drugs & Aging
Published in: Drugs & Aging 8/2015

01-08-2015 | Current Opinion

The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy

Authors: Jess W. Brallier, Stacie Deiner

Published in: Drugs & Aging | Issue 8/2015

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Abstract

Spine surgery is one of the most common surgeries for adults greater than 65 years of age. Optimizing and caring for the elderly patient presenting for spine surgery requires planning and multidisciplinary input from surgeons, primary care physicians, and anesthesiologists. Controversies exist surrounding appropriate perioperative management of complicated chronic medication regimens and the ideal selection of intraoperative therapy for these patients. In this article we present an overview of the controversies anesthesiologists face as they work with the elderly patient’s primary doctor and surgical team to achieve a safe perioperative course. Specifically, we discuss the interaction of geriatric physiology and pathophysiology with medications used in the perioperative period. While care of the geriatric spine surgery patient is nuanced, the anesthesiologist can work together with medical personnel, surgeons, and pharmacy to provide safe and effective care.
Literature
1.
Cloyd JM, Acosta FL, Ames CP. Complications and outcomes of lumbar spine surgery in elderly people: a review of the literature. J Am Geriatr Soc. 2008;56(7):1318–27.CrossRefPubMed
2.
3.
4.
Zhu K, Devine AM, Dick IM, et al. Association of back pain frequency with mortality, coronary heart events, mobility, and quality of life in elderly women. Spine (Phila Pa 1976). 2007;32(18):2012–8.CrossRef
5.
Picone DM, et al. Predictors of medication errors among elderly hospitalized patients. Am J Med Qual. 2008;23(2):115–27.CrossRefPubMed
6.
Burda SA, Hobson D, Pronovost PJ. What is the patient really taking? Discrepancies between surgery and anesthesiology preoperative medication histories. Qual Saf Health Care. 2005;14(6):414–6.PubMedCentralCrossRefPubMed
7.
Cornu P, et al. Effect of medication reconciliation at hospital admission on medication discrepancies during hospitalization and at discharge for geriatric patients. Ann Pharmacother. 2012;46(4):484–94.CrossRefPubMed
8.
Frydenberg K, Brekke M. Poor communication on patients’ medication across health care levels leads to potentially harmful medication errors. Scand J Prim Health Care. 2012;30(4):234–40.PubMedCentralCrossRefPubMed
9.
Savigny P, et al. Early management of persistent non-specific low back pain: summary of NICE guidance. BMJ. 2009;338(b):1805.CrossRef
10.
American Geriatrics Society Panel on the Pharmacological Management of Persistent Pain in Older Persons. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc. 2009;57(8):1331–1346.
11.
Dumont AS, et al. Nonsteroidal anti-inflammatory drugs and bone metabolism in spinal fusion surgery: a pharmacological quandry. J Pharmacol Toxicol Methods. 2000;43(1):31–9.CrossRefPubMed
12.
Thaller J, et al. The effect of nonsteroidal anti-inflammatory agents on spinal fusion. Orthopedics. 2005;28(3):299–303.PubMed
13.
O’Connor JP, Lysz T. Celecoxib, NSAIDs and the skeleton. Drugs Today (Barc). 2008;44(9):693–709.CrossRef
14.
Goldstein CL, Bains I, Hurlbert RJ. Symptomatic spinal epidural hematoma after posterior cervical surgery: incidence and risk factors. Spine J. 2013;15(6):1179–87.CrossRefPubMed
15.
Scott WW, et al. Assessment of common nonsteroidal anti-inflammatory medications by whole blood aggregometry: a clinical evaluation for the perioperative setting. World Neurosurg. 2014;82(5):e633–8.CrossRefPubMed
16.
Durmus M, et al. The post-operative analgesic effects of a combination of gabapentin and paracetamol in patients undergoing hysterectomy: a randomized clinical trial. Acta Anaesthesiol Scand. 2007;51(3):299–304.CrossRefPubMed
17.
Yu L, et al. Gabapentin and pregabalin in the managment of postoperative pain after lumbar spinal surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013;38(22):1947–52.CrossRef
18.
Khurana G, et al. Postoperative pain and long-term functional outcome after administration of gabapentin and pregabalin in patients undergoing spinal surgery. Spine (Phila Pa 1976). 2014;39(6):E363–8.CrossRef
19.
Ozgencil E, et al. Perioperative administration of gabapentin 1,200 mg day-1 and pregabalin 300 mg day-1 for pain following lumbar laminectomy and discectomy: a randomised, double-blinded, placebo-controlled study. Singap Med J. 2011;52(12):883–9.
20.
Ture H, et al. The analgesic effect of gabapentin as a prophylactic anticonvulsant drug on postcraniotomy pain: a prospective randomized study. Anesth Analg. 2009;109(5):1625–31.CrossRefPubMed
21.
Opioids for persistent pain. summary of guidance on good practice from the British Pain Society. Br J Pain. 2012;6:9–10.CrossRef
22.
Pergolizzi J, et al. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract. 2008;8(4):287–313.CrossRefPubMed
23.
van Ojik AL, et al. Treatment of chronic pain in older people: evidence-based choice of strong-acting opioids. Drugs Aging. 2012;29(8):615–25.CrossRefPubMed
24.
25.
26.
Shamliyan TA, et al. Epidural steroid injections for radicular lumbosacral pain: a systematic review. Phys Med Rehabil Clin N Am. 2014;25(2):471–89.CrossRefPubMed
27.
Friedly JL, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med. 2014;371(1):11–21.CrossRefPubMed
28.
Eskin B, et al. Prednisone for emergency department low back pain: a randomized controlled trial. J Emerg Med. 2014;47(1):65–70.CrossRefPubMed
29.
Scott NA, Moga C, Harstall C. Managing low back pain in the primary care setting: the know-do gap. Pain Res Manag. 2010;15(6):392–400.PubMedCentralPubMed
30.
Richards ML, et al. The rapid low-dose (1 microgram) cosyntropin test in the immediate postoperative period: results in elderly subjects after major abdominal surgery. Surgery. 1999;125(4):431–40.CrossRefPubMed
31.
Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA. 2002;287(2):236–40.CrossRefPubMed
32.
Smith I, Jackson I. Beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia? Curr Opin Anaesthesiol. 2010;23(6):687–90.CrossRefPubMed
33.
Turan A, et al. Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery. Anesth Analg. 2012;114(3):552–60.CrossRefPubMed
34.
ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Nucl Cardiol. 2015;22(1):162–215.
35.
POISE Study Group, Devereaux PJ, Yang H, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial. Lancet. 2008;371(9627):1839–47.CrossRef
36.
Lindenauer PK, et al. Perioperative beta-blocker therapy and mortality after major noncardiac surgery. N Engl J Med. 2005;353(4):349–61.CrossRefPubMed
37.
London MJ, et al. Association of perioperative beta-blockade with mortality and cardiovascular morbidity following major noncardiac surgery. JAMA. 2013;309(16):1704–13.CrossRefPubMed
38.
Gerstein NS, et al. Should more patients continue aspirin therapy perioperatively? Clinical impact of aspirin withdrawal syndrome. Ann Surg. 2012;255(5):811–9.CrossRefPubMed
39.
Antithrombotic Trialists (ATT) Collaboration, Baigent C, Blackwell L, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849–60.CrossRef
40.
Devereaux PJ, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494–503.CrossRefPubMed
41.
42.
Arneric SP, et al. Tailoring chronic pain treatments for the elderly: are we prepared for the challenge. Drug Discov Today. 2014;19(1):8–17.CrossRefPubMed
43.
Deiner SG, et al. Patient characteristics and anesthetic technique are additive but not synergistic predictors of successful motor evoked potential monitoring. Anesth Analg. 2010;111(2):421–5.CrossRefPubMed
44.
Smischney NJ, et al. Ketamine/propofol admixture (ketofol) is associated with improved hemodynamics as an induction agent: A randomized, controlled trial. J Trauma Acute Care Surg. 2012;73(1):94–101.CrossRefPubMed
45.
Loftus RW, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113(3):639–46.PubMed
46.
Deiner S, et al. Do stress markers and anesthetic technique predict delirium in the elderly. Dement Geriatr Cogn Disord. 2014;38(5–6):366–74.CrossRefPubMed
47.
Sieber FE, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clinic Proc. 2010;85(1):18–26.CrossRef
48.
Chan MT, et al. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013;25(1):33–42.CrossRefPubMed
49.
Radtke F, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth. 2013;110(Suppl 1):i98–105.CrossRefPubMed
50.
Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112(6):991–1004.CrossRefPubMed
51.
Kim SH, et al. Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review. Front Pharmacol. 2014;8(5):108.
52.
Gottschalk A, Durieux ME, Nemergut EC. Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg. 2011;112(1):218–23.CrossRefPubMed
53.
Pacreu S, et al. The perioperative combination of methadone and ketamine reduces post-operative opioid usage compared with methadone alone. Acta Anaesthesiol Scand. 2012;56(10):1250–6.CrossRefPubMed
54.
Cheriyan T, et al. Efficacy of tranexamic acid on surgical bleeding in spine surgery: a meta-analysis. Spine J. 2015;15(4):752–61.CrossRefPubMed
55.
Li Zhi-Jun, et al. Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J. 2013;22:1950–7.PubMedCentralCrossRefPubMed
56.
Hunt BJ. The current place of tranexamic acid in the management of bleeding. Anaesthesia. 2015;70(1):50–3.CrossRefPubMed
57.
Nardi K, et al. Ischaemic stroke following tranexamic acid in young patients carrying heterozygosity of MTHFR C677T. Ann Clin Biochem. 2011;48:575–8.CrossRefPubMed
Metadata
Title
The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy
Authors
Jess W. Brallier
Stacie Deiner
Publication date
01-08-2015
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 8/2015
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.1007/s40266-015-0278-5

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