Improvements in microsurgical and neuroanesthesiological have resulted in an increasing number of operation for aneurysm clipping in elderly patients. It is the purpose of this article to evaluate surgical outcome of elderly patients(stand point of three groups), considering neurologic grade on admission, amount of subarachnoid hemorrhage(SAH) on computerized tomography(CT) findings and timing of surgery.

The subjects of the present study are 34 patients who were admitted to department of neurosurgery and treated surgically between 1991 and 1997 in Mok-Dong and Tongdaemun hospital. All the patients in this study were verified as having aneurysmal SAH on CT scanning followed b cerebral argiography. The patients were classified by age into three groups : 65 to 70 years(24 cases), 76 years(7 cases) and 76 years or older(3 cases). On admission, the clinical condition of patients was graded according to the scals of Hunt and Hess and the amounts of SAH was graded according to grading system of Fisher. The day 7 SAH was defined as Day O. the timing of operation was divided into three. 1-3 days ; 3-7 days; 8-days.

The surgical mortality according to the different age groups, Hunt-hess grade, grading system of Fisher and timing of operation was analised.

Overall, 11 of the 34 patients died, for a mortality rate 32%. The mortality rate by age groups was 21% for 65 to 70 years, 57% for 71 to 75 years and 20% for 76 years of older. The mortality rate by Hunt-Hess grade was 35%, in I-II, 33% in III and 20% in IV-V, and the mortality rate as related to grading system of Fisher was 0% in 1, 36% in 2, 36% in 3 and 25% in IV. The mortality rate according to timing of operation was 31% in 1-3 days, 25% in 3-7 days and 25% in over days.

In recent years, with improvement in surgical technique and neuroanesthesia, the number of operation for ruptured aneurysm have increased in elderly patient. A more aggressive treatment in elderly patients is justified.

As the number of elderly people rises, the incidence of surgery in elderly patients would become higher. This study was undertaken to examine the changes in pulmonary gas exchange that occurs with advancing age.

Arterial blood gases were analysed in 106 elderly patients over the age of 65 and 40 adult patients(control group) during breathing of room air preoperatively. Alveolar oxygen partial pressure(PAO₂), alveolar-arterial partial pressure gradient for oxygen(AaDO₂), arterial/alveolar oxygen partial pressure(a/A) ratio were calculated using PaO₂ and PaCO₂ and PAO₂ and measured the relationship between the PaO₂ and age.

PaO₂ declined as age increased significantly and the regression equation was PaO₂=103.6-0/332×age(r=0.55). There was no significant difference in PaCO₂ and PAO₂ but AaDO₂ increased and a/A ratio decreased significantly.

As the AaDO₂ and a/A ratio were changed significantly, it is necessary for monitoring of oxygenation during perioperative periods in elderly patients.

The purpose of this study was to compare the safety and efficacy of midazolam sedated Endoscopic retrograde cholangiopancreatography (ERCP) with unsedated ERCP in patients 70 years of ages and older.

Seventy elderly patients 70 years of age or older who underwent ERCP were divided into two groups: midazolam sedated group (n=43) and unsedated group (n=27). Procedure time, success rate, complications related with ERCP procedure, satisfaction score were analyzed between two groups.

Mean procedure time was 20.6 minutes for sedated group and 21.0 minutes for unsedated group (P=0.88). Success rate was 87.5% for sedated group and 100% for unsedated group (P=0.07). Incidence of complications from ERCP procedure showed no significant differences between the sedated and unsedated groups (P=0.10). There was no mortality in both groups related to the sedation or post-ERCP complication. Compared to the unsedated procedure, the sedated ERCP procedure was associated with higher patient satisfaction (P<0.001) and better repeat compliance (P=0.004).

There was no significant difference in success rate and complications at sedated and unsedated ERCP in patients 70 years of age and older. Unsedated ERCP showed 66.6% satisfaction score compared to sedated ERCP.

As the general population ages increase leading to an increase in the demand for therapeutic ERCP interventions. The aims of this study are to assess the outcomes, safety and complications associated with ERCP performed in elderly patients.

ERCP was performed in 287 patients aged 70years or over from Jan. 2000 to Dec. 2005. All the patients were evaluated and retrospectively reviewed. The main indications, complications, success rate, mortality and risk factors of procedure were analysed.

287 patients(162 females and 122 males, mean age 78 years, range 70-94years) underwent diagnostic and therapeutic ERCP. Mortality rate was 0.03% and success rate was 91.7%. Minor complications including procedure-related complications such as pancreatitis(2.8%), minor bleeding(1.4%), and aggravated cholangitis(2.1%), mild hypoxia(SaO₂ < 90%, 15.1%), premature ventral contraction(1.0%), and tachycardia(50.7%) were transient. Major events were presented as severe hypoxia(SaO₂ < 85%) in three pts(1.0%), and atrial fibrillation in one patients (0.03%).

This study showed that diagnostic and therapeutic ERCP is safe in elderly patients. Minor complications are usually transient and mortality is similar to previous reported rate.