Geriatric patients - NYSORA

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Geriatric patients

Learning objectives

  • Describe the physiological changes associated with aging
  • Manage geriatric patients presenting for surgery

Background

  • Geriatric patients often present with conditions requiring surgery
  • Age increases perioperative risks associated with anesthesia
  • Geriatric patients have a greater risk of perioperative morbidity and mortality

Physiological changes

Aging, tachycardic, preload, baroreceptor, contractility, hypovolemia, systemic vascular resistance, pulse pressure, coronary artery disease, left ventricular hypertrophy, aortic valve calcification, arrhythmia, atrial fibrillation, pacemaker, defibrillator, anticoagulant, memory loss, cognitive decline, dementia, delirium, depression, inspiratory capacity, ventilation-perfusion mismatch, functional residual capacity, closing capacity, atelectasis, shunting, hypoxia, hypercarbia, gram-negative bacteria, glomerular filtration rate, acute kidney injury, nephrotoxic, malnutrition, thermoregulation, diabetes mellitus

Common surgeries in the elderly

  • Cataract surgery
  • Trans-urethral resection of the prostate
  • Hip fracture surgery
  • Knee arthroplasty
  • Cholecystectomy
  • Pacemaker implantation
  • Colorectal excision
  • Breast excision

Management

geriatric patients, cognitive impairment, frailty, blood tests, comorbidities, induction, inhalational, sevolfurane, desflurane, neuromuscular blocking, hypotensin, vasopressors, ephedrine, metaraminol, phenylephrine, urinary catheter, hypovolemia, overhydration, normothermia, pressure points, adhesive tape

Suggested reading

  • Staheli B, Rondeau B. Anesthetic Considerations In The Geriatric Population. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572137/
  • Murray D, Dodds C. Perioperative care of the elderly. Continuing Education in Anaesthesia Critical Care & Pain. 2004;4(6):193-6.

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