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Intro Anesthesia > Aging > Flashcards

Aging Flashcards

1
Q
A
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2
Q

Peak age of increased organ function (functional reserve).

A

Around 30

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3
Q

Age of gradual/rapid decline organ function (functional reserve).

A

80

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4
Q

Age process is highly variable. T/F

A

True

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5
Q

What further diminishes functional organ reserve.

A

Disease interaction

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6
Q

Sensory changes with age.

A

DECREASED

Salivation

Taste buds for sweat & salty

Visual acuity

Sensitivity to sound

Response to pain

Thirst sensation

Motor skills

General - changes in dentition

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7
Q

Renal changes with aging.

A

DECREASED

Renal capacity

Renal blood flow

Glomerulofiltration

Renal drug clearance and metabolism

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8
Q

CNS changes with aging

A

DECREASED

Neuronal density

Reflexes

Sympathetic response

Proprioception

Baroreceptor response (postural hypotension)

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9
Q

GI changes with aging

A

DECREASED

GI absorption

Gastric emptying

Hepatic BF / Drug clearance

Drug absorption

Motility

Transit time

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10
Q

Cardiovascular changes with aging (increases)

A

INCREASED

Myocardial irritability

Dysrhythmia

(PVC, PAC, inc AV Block, dec max HR, dec sinus rate) Systolic BP

Circulation time

Conduction changes

Defective ischemic preconditioning

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11
Q

Endocrine chaos gets with aging

A

High or low thyroid function

Dec insulin sensitivity

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12
Q

Ortho changer with aging

A

Osteopenia

High fracture risk

Dec ROM

Dec ligamentous stiffness

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13
Q

Immune changes in aging

A
  1. Dec neurohormonal response
  2. Dec WBC reserve (secondary to bone marrow splenic stenosis)
  3. Sluggish T-cell response
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14
Q

Aging: response to beta receptor stimulation

A

Reduced capacity to inc HR in response to low BP, hypovolemia, and hypoxia

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15
Q

Myocardium, arteries and veins become soft or stiffer?

A

Stiffer

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16
Q

Cariovascular

Aging changes in ANS

A

Cardiovascular

Increased SNS

decreased PNS

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17
Q

Rhythm disturbances

A

Fibrosis of conduction system (blocks)

Sick sinus syndrome

A fib prevalence

Calcification in valves

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18
Q

Ischemic preconditioning: brief periods of myocardial ischemia will LESSEN or INCREASE effects of subsequent, more prolonged ischemic event

A

Ischemic preconditioning: brief periods of myocardial ischemia will LESSEN effects of subsequent, more prolonged ischemic event

Diminished or eliminated with age

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19
Q

Manifestation of arterial stiffening due to

A

Widened pulse pressure

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20
Q

Pulse pressure > _________ mmHg is associated with 3 things

A

80

  1. All cause mortality
  2. Cardio mortality
  3. Variety of comorbidities
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21
Q

HTN risk for periop complications. Risk ____ for every ____mmHg in sbp and ___ mmHg in dbp

A

Doubles

20sbp

10 dbp

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22
Q

HTN caused by

A

Increased PVR, dec arterial elasticity and cardiac workload

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23
Q

Most common complication and leading cause of death

A

Myocardial infarction

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24
Q

Most prominent pulmonary changes with aging

A

Inc chest wall stiffness

Dec stiffness of lung parenchyma

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25
Q

Chest wall stiffening does what in aging

A

Increases work of breathing

More barrel shaped

Flattened diaphragm

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26
Q

What makes elderly more prone to fatigue when challenged by inc minute ventilation?

A

Stiff chest wall

Flattened diaphragm

Loss muscle mass make

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27
Q

What causes decreased lung stiffness

A

Loss of elastin

Easier to inflate (more compliance)

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28
Q

Dr. Thurman clarified there is decreased in CHEST WALL compliance and increase in LUNG compliance.

Adverse effects of increased LUNG compliance

A
  1. Need further lung inflation to prevent small airway collapse
  2. Inc VQ mismatch
  3. Greater limitation during forced exhalation
  4. Predisposition to upper AW Obstruction
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29
Q

Closing capacity is ______

CC is > or < FRC in erect position in 65 or older

A

Increased

CC > FRC at 65

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30
Q

VQ change with inc compliance

A

Increased VQ

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31
Q

___% decrease in response to hypercapnea and hypoxia

A

50 %

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32
Q

Best indicator of drug clearance

A

Creatinine clearance

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33
Q

What is the Cockcroft formula?

Can overestimate or underestimate?

A

(140 – age) x (LBW weight in kg) (x 0.85 if female)

72 x (serum creatinine)

May overestimate

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34
Q

Elderly with impaired renal at risk for

A

Fluid overload

Metabolite and renal excreted drug accumulation

Decrease drug elimination

Electrolyte imbalances

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35
Q

Aging on liver function

A

Increased fibrosis

Inc oxidants

Dec mass and integrity

Dec BF 20-40% ↓

Dec insulin sensitivity

Modest reduction in phase I metabolism ( oxidation, reduction, & hydrolysis); mediated by cytochrome P450 system

Modest ↓ in bile production

Metabolism of most anesthetic agents as well as nondepolarizers affected by age-related changes

Age not a factor in Phase II (conjugation, sulfonic acid, acetylation)

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36
Q

Brain/neuron changes: list 3

Most prominent where?

In a 90 y/o brain, what happens ventrilce size?

Sulci?

A

Neuron changes

  1. Progressive loss of neurons and neuronal substance
  2. Dec in neurotransmitter activity
  3. Dec in brain size

Most prominent in

Cerebral cortex, especially frontal lobes

In a 90 y/o brain, ventrilce increase in size.

Sulci become deeper.

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37
Q

Result of progressive dec in brain mass and neuronal substances. List 4

A
  1. Dec CSF
  2. nerve conduction velocity
  3. Degeneration of peripheral nerve cells
  4. Number of myelinated nerve fibers
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38
Q

Effects of GA on regulation of brain

And induction dose changes needed

A

Inc sensitivity to anesthetics

Inc risk for delirium

Inc sensitivity bc of dec number of receptors

(dec dose of induction agent 30-40%)

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39
Q

Neuraxial implications

A

Neural damage with regional

Anatomic changes

Enhanced spread of LA

Epidural test dose less reliable

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40
Q

Anatomic neuraxial changes

A
  1. Intervertebral disc height
  2. Narrow intervertebral foramina
  3. Dec space btw spinous process
  4. Calcification
  5. Lordosis
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41
Q

Post Op Delirium:

Definition

Characrteristics

Onset

Pathogenesis/risk factors

A

Post Op Delirium: transient reversible state of cognitive alteration after surgery

Characrteristics: disruption of perception, thinking, memory, psychomotor behavior, sleep-wale cycle, consciousness, & attention

Onset: subtle

Pathogenesis: multifactorial; dec synthesis/release of ACh, older age, male gender, dementia, history of alcohol abuse, depression, duration of anesthesia, anesthesia stimulated vasodilation -> hypermetabolic state in brain, poor functional status, abnormal electrolytes & glucose, Parkinson’s disease, cardiovascular disease, dehydration, metabolic disease (diabetes, hyperthyroidism), anticholinergics, ICU, inadequate pain control & type of procedure (ortho! cardio!)

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42
Q

Changes in kinetics of medications

  1. Drug redistribution phase – blood concentrations level higher/lower:
  2. Mildly contracted blood volume
  3. ↓ muscle mass speeds/slows removal of drug from blood
  4. Induction gives moderate-to-severe hypotension
  5. ↓/↑ vol of distribution of water-soluble meds → ↑ plasma concentration
  6. ↓/↑ total body fat → fat-soluble meds have longer half-life. However, Thurman clarified, there is a decrease in subcutaneous fat/tissue.
  7. Target organ may be more sensitive/insensitive to drug level
  8. IV bolus takes longer/faster to take greater effect?
A

Changes in kinetics of medications

  1. Drug redistribution phase – blood concentrations level higher:
  2. Mildly contracted blood volume
  3. ↓ muscle mass slows removal of drug from blood
  4. Induction gives moderate-to-severe hypotension
  5. ↓ vol of distribution of water-soluble meds → ↑ plasma concentration
  6. ↑ total body fat → fat-soluble meds have longer half-life. However, Thurman clarified, there is a decrease in subcutaneous fat/tissue.
  7. Target organ may be more sensitive to drug level
  8. IV bolus takes longer to take greater effect?
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43
Q

Circulation time is ____.

A

Slower

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44
Q

Rate of transfer into organs

A

Slower

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45
Q

Drug effects are result of tissue/plasma concentration.

A

Drug effects are result of Tissue (not plasma) concentration.

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46
Q

BBB crossing is quicker or longer?

A

Longer

No explanation for this

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47
Q

Drugs distribute based on ______& ______.

A

Tissue mass and solubility

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48
Q

Most IV anesthetics are ___ soluble, end up in ____ after initial redistribution in vessel- _____group.

A

Most IV anesthetics are lipid soluble, end up in fat after initial redistribution in vessel-rich group.

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49
Q

Most prominent and consistent pharmacokinetics is decrease in drug ___________.

A

Drug metabolism

Dec in clearance

Inc Vd ss

(?Due to inc in body fat)

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50
Q

GFR is ____

Renal eliminating drug metabolism is _____ bc of this.

What effect on elim half life.

A

GFR is dec

Renal eliminating drug metabolism is dec bc of this.

Doubles effect on elim half life.

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51
Q

3 Drugs to avoid in elderly due to SE from central anticholinergics!!

A
  1. Scopalomime
  2. Phenergan
  3. Chlorpheniramine

Haldol (small anticholinergic properties - smaller doses for agitation and nausea usually okay)

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52
Q

*Time to dec effect site concentration is ____ by aging when a large % ____ in plasma level if necessary to dip below therapeutic threshold*

A

*Time to dec effect site concentration is increase by aging when a large % decrease in plasma level if necessary to dip below therapeutic threshold*

* astrics used on slides, who knows

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53
Q

Sensitivity of opioids is _____. Pharmacokinetics are ______ according to Barash.

A

More

Unaffected

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54
Q

For drugs elimination by kidney & liver, the effect of a bolus are eliminated by _________, multiple doses will result in ____________ with subsequent doses have a more _______ effect.

A

Redistribution

Accumulation

Prolonged

55
Q
  1. Generally, elderly are ____ sensitive to anesthetic drugs.
  2. Factors: plasma protein binding, body content, drug metabolism & pharmacodynamics
  3. Main plasma binding protein: ____
  4. _↓↑_Albumin with age
  5. _↓↑_α1-acid glycoprotein levels
  6. _↓↑_lean body mass
  7. ↓↑ body fat (greater volume of distribution)
  8. _↓↑_total body water (smaller central compartment & ↑serum concentration after bolus of hydrophilic drug)
  9. Drug effect depends on which ____ drug is bound to
  10. In general, plasma binding protein levels not/is a predominant factor in how aging affects pharmacokinectics
A
  1. Generally, elderly are more sensitive to anesthetic drugs.
  2. Factors: plasma protein binding, body content, drug metabolism & pharmacodynamics
  3. Main plasma binding protein: albumin
  4. ↓ Albumin with age
  5. ↑ α1-acid glycoprotein levels
  6. ↓ lean body mass
  7. ↑ body fat (greater volume of distribution)
  8. ↓ total body water (smaller central compartment & ↑serum concentration after bolus of hydrophilic drug)
  9. Drug effect depends on which protein drug is bound to
  10. In general, plasma binding protein levels not a predominant factor in how aging affects pharmacokinectics
56
Q

Hemodynamic response results of interactions with aging ______ and _________.

A

Hemodynamic response results of interactions with aging heart and vasculature.

57
Q

Compensatory or reflex responses are blunted or absent T/F?

A

Compensatory or reflex responses are blunted or absent T/F?

58
Q

Mac is decreased approx __% per ______.

A

MAC dec 6% per decade

59
Q

Altered activity of neuronal ion channels are associated with what receptors.

A

Nicotinic

ACh

GABA

Glutamate

60
Q

Thiopental changes seen

A

No change in brain sensitivity with

61
Q

Most common 3 system complications

A

neuro

pulm

cardiac

62
Q

Relative risk for 90 day mortality for any ADL and IADL impairment (instrumental ADL)

A

ADL - RR 1.9

IADL - RR 2.4

63
Q

ADLs - 5 of them

A

bathing

dressing

toileting

transferring

eating

64
Q

Instrumental ADLs - 7 of these

A

telephone

use public transportation

use shopping

meal prep

housekeeping

taking meds

properly managing finances

65
Q

Multisystem loss of physiologic reserve; vulnerable to disability after stress

A

Frailty

prognostic factor for poor outcomes

66
Q

Components of Frailty

A

mobility

muscle weakness

poor exercise tolerance

unstable balance

body composition factors

(weight loss, malnutrition, & muscle wasting)

Chronic inflammation & endocrine dysregulation “key drivers”

67
Q

5 Criteria used to define

Frailty

(Which is a prognostic factor for poor outcomes - thought I’d throw that in there)

A

Weight loss

Exhaustion

Physical activity

Walk time

Grip strength

68
Q

Quesioning weight loss criterion.

A

“In the last year, have you lost more than 10 lb unintentionally (i.e., not as a result of dieting or exercise)?” Patients answering “Yes” are categorized as frail by the weight loss criterion.

69
Q

Questioning exhaustion criterion

A

The patient is read the following two statements: (1) I felt that everything I did was an effort; (2) I could not get going. The question is asked, “How often in the last week did you feel this way?” The patient’s response is rated as follows: 0 = rarely or none of the time (<1 day); 1 = some or little of the time (1 to 2 days); 2 = a moderate amount of the time (3 to 4 days); or 3 = most of the time. Patients answering “2” or “3” are categorized as frail by the exhaustion criterion.

70
Q

Questioning about Physical activity criterion

A

The patient is asked about weekly physical activity.

Patients with low physical activity are categorized as frail by the physical activity criterion.

71
Q

Questions about walk time criterion

A

The patient is asked to walk a short distance and timed.

Patients who are slow walkers are categorized as frail by the walk time criterion.

72
Q

Questioning about strength criterion

A

The patient’s grip strength is measured.

Patients with decreased grip strength are categorized as frail by the grip strength criterion.

73
Q

Atypical Presentation of Disease

Primarily linked to presence of

A

Dementia

NOT a characteristic feature of aging process

74
Q

(Topic: malnutrition, immobility and dehydration)

Which is associated with

↑ morbidity, mortality & length of stay

A

Malnourishment

75
Q

(Topic: malnutrition, immobility and dehydration)

Which is associated with loss of skeletal muscle, ventricular atrophy, hypovolemia, & orthostatic intolerance

A

Bedrest

76
Q

(Topic: malnutrition, immobility and dehydration)

Which is associated with hypernatremia & infection

A

Dehydration

77
Q

Leading cause of unintential falls

A

Trauma

Primary goal: prevention

Anticoags: highest mortality in head injury

78
Q

(Chronic pain) Most prevalent indication for analgesics

A

Arthritis

79
Q

Consequence of persistent pain:

A

depression

sleep disturbance

impaired ambulation

80
Q

Fill in blank

A
81
Q

Fill in blank

A
82
Q

No evidence that use of either regional vs general anesthesia can alter 30 day mortality in elderly T/F

A

True

No alateration in 30 day mortality in studies

83
Q

Specific benefits of regional anesthesia

A

1) prevent postop inhibition of fibrinolysis
2) ↓ blood loss in pelvic & lower extremity surgery
3) no instrumentation of airway → patients maintain their own airway & level of pulmonary function
4) opiate-sparing effects
5) improved postop pain control

84
Q

Regional anesthesia use

A

Ortho

prostate

gynecologic

LE vascular

85
Q

Placement of needle for epidural or spinal block may be difficult

A
  1. Calcification of interspinous ligament & ligamentum flavum
  2. Narrowing of intervertebral foramina
  3. Reduction in flexibility → difficulty positioning
86
Q

Spread of LA in epidural space is exaggerated T/F

A

True

goes to higher level

87
Q

Spead in spinal is narrow

A

False

Wide

Should decrease dose in spinals

88
Q

Most common hemodynamic event in regional anesthesia.

A

Hypotension

Exaggerated in pts with HTN

Pretx with crystalloid NOT consistent in prevention

89
Q

Hypotension is most likely due to

A

Vasodilation

Sympathetic Blockade

Decreased SVR

Decreased CVP

Redistribution of blood volume to the extremities from central splanchnic & mesenteric vascular bed.

90
Q

Hypotension is of particular concern in very elderly patients with limited _____ ________, and may be exaggerated in patients with baseline hypertension.

A

Hypotension is of particular concern in very elderly patients with limited cardiac reserve, and may be exaggerated in patients with baseline hypertension.

Pretreatment with crystalloid does not consistently offset the hypotension following a spinal block

91
Q

This assessment associated with masking more difficult; laryngoscopy easier

A

Edentulous

92
Q

Hx of this may limit head & neck manipulation with DL (think basic)

A

Arthritis

93
Q

This disease may predispose to cerebral ischemia during neck manipulation

A

Vertebrobasilar disease

(can’t be rough on trying to get the axis all line up - cerebral ischemia!!)

94
Q

Used to treat exaggerated response to laryngoscopy?

A

Lidocaine 50 mg IV or short-acting beta-blocker may attenuate

95
Q

Risk of pulmonary aspiration is due to

A

Decreased pharyngeal responses

96
Q

Prolonged periods of intraop hypotension → ↑ in postop morbidit maintain BP within ___% of baseline

A

Prolonged periods of intraop hypotension → ↑ in postop morbidit maintain BP within 10% of baseline

97
Q

Propofol implications

A
  1. hemodynamic effects can be greatly exaggerated in elderly
  2. ↓ initial dose & time interval between repeated doses
  3. Rapid recovery with minimal delayed cognitive effects
  4. ↑ brain sensitivity
98
Q

Etomidate implications

A
  • 30-60% of patients develop myoclonus
  • Minimal cardiovascular effects
  • Excellent for emergencies
  • Volume of distribution ↓ - 50% ↓ in dose recommended
99
Q

The hemodynamic effects of propofol can be greatly exaggerated in elderly patients, especially if their intravascular volumes are depleted possibly leading to significant cardiac or cerebral ischemia. Propofol infusion probably provides a more stable hemodynamic course.

no thinking required here just enjoy the paragraph

A

The hemodynamic effects of propofol can be greatly exaggerated in elderly patients, especially if their intravascular volumes are depleted possibly leading to significant cardiac or cerebral ischemia. Propofol infusion probably provides a more stable hemodynamic course.

100
Q

Etomidate, carboxylated imidazole ring, produces some ________ effects leading to development of myoclonus, in about 30-60% of patients

A

Etomidate, carboxylated imidazole ring, produces some disinhibitory effects leading to development of myoclonus, in about 30-60% of patients

101
Q

What do you know about Midazolam for elderly?

A
  • short duration, absence of active metabolites & CV effects
  • Pharmacokinetic changes prolong elimination, but ↑ sensitivity due to pharmacodynamic change in benzodiazepine GABA receptor
  • ↓dose 50-75%; repeat doses 0.5 mg or less
  • Susceptible to midazolam-induced apnea
  • Unwanted effects reversed with flumazenil
  • Long-acting benzodiazepines associated with delirium in elderly due to prolonged clearance & active metabolites
102
Q

Inhaled anesthetics implications

A
  • MAC ↓ 6% every decade after age 20 years
  • MAC at 90 yo ↓ by 30% compared to 40 yo
  • Due to cerebral atrophy & alterations in neurotransmitter balance
103
Q

Aging does ↑ sensitivity to muscle relaxants at NMJ

T/F

A

False

Aging does not ↑ sensitivity to muscle relaxants at NMJ

104
Q

Muscle relaxant implications

A
  • Other age-related changes may ↑ sensitivity or ↓ elimination (Thurman said in her experience, MR do not last as long actually)
  • Avoid pancuronium because 85% eliminated by kidneys
  • Vecuronium & rocuronium less dependent on renal excretion, yet elim t 1/2 is proloned
  • Cisatracurium/atracurium not impacted by hepatic/renal function
105
Q

Opioid pharmacodynamic changes account for ↑ sensitivity of brain T/F

A

True

  1. Sufentanil, alfentanil, fentanyl, remi 2 x as potent in older adult
  2. ↑ in brain sensitivity (not altered pharmacokinetics)
  3. ↑ brain sensitivity (½ bolus dose)
  4. Vol of central compartment, Vl & clearance ↓ (1/3 infusion rate)
106
Q

General opioid implications

A
  1. Pharmacodynamic changes account for ↑ sensitivity of brain
  2. Pharmacokinetics changes on elimination/distribution less significant
  3. ↓ dose by 50%
  4. Variability of response common among elderly; titrate to effect
107
Q

Fentanyl implications

A

Short-acting lipid-soluble

large VD

↓ dose by 50%

108
Q

Remi implications

A
  1. ultrashort-acting Mu receptor agonist
  2. Metabolized by plasma esterases
  3. Bolus & infusion dose reduced & tritrated
109
Q

Morphine implications

A
  1. ↓ VD
  2. metabolites morphine 3-glucuronide & morphine 6-glucuronide eliminated by kidneys →potential accumulation
110
Q

Meperidine implications

A

Not recommended

except for shivering with smaller doses

12.5-25 mg

can cause delirium

111
Q

MAC Concept: ______ dose or infusion but _____ interval

A

MAC Concept: reduce dose or infusion but increase interval

112
Q

Monitored anesthesia care

Patients are susceptible to what 2 things per Thurman’s slides

A

Monitored anesthesia care

Patients are susceptible to hypoventilation & apnea

113
Q

Tx/Drugs to use for MAC

A
  1. Supplemental O2 & monitoring of ETCO2 recommended
  2. Drugs used include benzodiazepines (midazolam), fentanyl, remifentanil
  3. I include propofol
  4. Ketamine 10-30 mg IV useful
  5. Dexmedetomidine (centrally acting α2-agonist) – no adverse respiratory effects; provides analgesia & sedation
  6. Side effects of Dex: prolonged sedation, bradycardia, hypotension
114
Q

How to dilute precedex

A

Precedex

Dilute with sterile saline to a concentration of

4 mcg/mL

(2 ml of precedex added to 48 mL of saline)

115
Q

Precedex dosing

loading

mainenance infusion

adjustment for elderly

A

Precedex dose:

  1. 1 mcg/kg IV over 10 minutes for loading dose
  2. maintenance infusion of 0.2-0.7 mcg/kg/hr up to 24 hours.
  3. Rate of maintenance is titrated to desired level of sedation.
  4. Decrease dose for elderly.
116
Q

Look at this

A
117
Q

Review

A
118
Q

Review

A

The few with No increased brain sensitivity, BUT have dec initial Vd

Etomidate

Thiopental

N/A for brain sensitivity

Panc

Cisatra

Atra

Few without any decreased clearance issues

inhaled

sufe

alfe

fenta

atra

cisatra

119
Q

Drugs with decreased clearance in elderly

A

etomidate

prop

midazolam

morphine

remi

panc

120
Q

Postop mgmt/considerations: what are some key points?

A
  1. Pulmonary problems of particular importance
  2. Most important patient-related factors are age, ASA status
  3. Greater incidence of postop desaturation
  4. Higher risk for aspiration due to progressive ↓ laryngopharyngeal sensory discrimination & associated dysfunctional swallowing
  5. Urinary retention more common in older adults
121
Q

Treatment of Acute Postoperative Pain

  1. Age-related ↓ pain perception (↓ nerve conductivity & receptors)
  2. Postop pain asso with what 4 things?
  3. Cognitively intact – recommend PCA
  4. Cognitively impaired report less pain
A

Treatment of Acute Postoperative Pain

  1. Age-related ↓ pain perception (↓ nerve conductivity & receptors)
  2. Postop pain asso with ↑ length of stay, ↑ morbidity, pulmonary complications, & delirium
  3. Cognitively intact – recommend PCA
  4. Cognitively impaired report less pain
122
Q

3 Principles for Tx of acute post op pain:

A

3 Principles for Tx of acute post op pain:

1) mult modalities (acetaminophen, gabapentin)
2) use site-specific analgesia – regional blocks
3) caution with NSAIDS - risk for renal failure & GIB

123
Q

Iatrogenic complications

A

Iatrogenic complications

Adverse drug events

dehydration

delirium

functional decline

124
Q

Outcomes

Goal of surgical intervention to preserve or improve activity & _________ while avoiding _______.

Functional recovery may be challenging & require time

A

Outcomes

Goal of surgical intervention to preserve or improve activity & independence while avoiding disability

Functional recovery may be challenging & require time

125
Q

Age has no effect on duration of motor blockade with bupivacaine T/F

A

Age has no effect on duration of motor blockade with bupivacaine T/F

126
Q

Neuraxial Anesthesia & Peripheral Nerve Blocks

  1. Age has ____ effect on duration of motor blockade with bupivacaine
  2. Time of onset increased/decreased.
  3. Spread is more diminished/extensive with hyperbaric bupivacaine
  4. Effect on duration of epidural with bupivacaine not known
  5. Ropivacaine ____% for PNB: ____ a major factor in determining duration of motor & sensory block
A

Neuraxial Anesthesia & Peripheral Nerve Blocks

  1. Age has no effect on duration of motor blockade with bupivacaine
  2. Time of onset ↓
  3. Spread is more extensive with hyperbaric bupivacaine
  4. Effect on duration of epidural with bupivacaine not known
  5. Ropivacaine 0.75% for PNB: age a major factor in determining duration of motor & sensory block
127
Q

Consider shorter acting anesthetics

  1. Shorter-acting opioid, such as ______.
  2. Shorter- acting muscle relaxants
  3. No significant difference in recovery profile of cognitive function with ______ ______.
  4. ______ inhalation agent is associated with the most rapid emergence
A

Consider shorter acting anesthetics

  1. Shorter-acting opioid, such as remifentanil
  2. Shorter- acting muscle relaxants
  3. No significant difference in recovery profile of cognitive function with inhaled anesthetics
  4. Desflurane associated with the most rapid emergence
128
Q

Most 5 important risk factors for periop complications (elderly)

A
  1. Age
  2. Physiologic status
  3. Coexisting disease (ASA)
  4. Elective or urgent surgery
  5. Type of procedure
129
Q

Chronologic age is less/more important than sum of cormorbidities

A

Chronologic age is < important than sum of cormorbidities

130
Q

Independent predictor of adverse events

A

Emergency

(poor preop and prep)

131
Q

NH considers elderly age at

A

65 or older

132
Q

POCD

  1. characterized by:
  2. Onset:
  3. Dx:
  4. Pathogenesis:
A

POCD

  1. characterized by: cognitive imprairments
  2. Onset: subtle & may not present for weeks to months postop
  3. Dx: no universal criteria
  4. Pathogenesis: multifactorial
133
Q

Incidence of POCD is similar with regional vs general.

T/F

A

True dat

Intro Anesthesia (5 decks)

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