Anesthesia for the Old Farts

Question 1

What is the definition of an elderly or geriatric patient?

Answer 1

There isn’t one. What is considered elderly changes with time

Question 2

Currently, the geriatric patient is what?

Answer 2

Considered to be any person 65 years old or older

Question 3

What is aging?

Answer 3

Aging is a normal and natural process and is not a disease

Question 4

What is said to be be aging successfully?

Answer 4

A result of having the least decline in function with time

Question 5

What cells are continuously replicating in all humans?

Answer 5

• -Gastrointestinal
• • Epidermal
• • Hematopoietic

Question 6

What cells are only replicate in response to a challenge in all humans?

Answer 6

Hepatic

Question 7

What cells are non-replicating in all humans?

Answer 7

• • Neurons
• • Skeletal muscle
• • Cardiac muscle

Question 8

What physiologic changes occurs in the geriatric population?

Answer 8

Pharmacokinetic and pharmacodynamic changes both result in increase or exaggerated pharmacologic effects of medications

Question 9

Why is more drug available in the geriatric population?

Answer 9

Because protein binding is less efficient in geriatrics causing less drug to be bound thus allowing more to be available to cause effects

Question 10

Over time, what is the general reduction of blood volume for geriatrics?

Answer 10

20-30%

Question 11

Most organ systems lose function at what rate per year starting at around 30 years old?

Answer 11

1 %

Question 12

What is the general changes in the Central nervous system?

Answer 12

• • Reduction in cerebral blood flow
• • Reduction in CMRO2
• • Decreased complex learning
• • Decreased hours of sleep
• • Increased motor response time

Question 13

What is the general changes in the cardiovascular system?

Answer 13

• • Stroke volume slightly decreased
• • Heart rate slightly decreased
• • Sclerosis of Heart valves
• • Decreased cardiac output
• • Decreased heart rate response to stress

Question 14

What is the general changes in the respiratory system?

Answer 14

• • Decreased vital capacity
• • Decreased cilia activity which results in retainment of secretions
• • Decreased respiratory muscle strength

Question 15

What is the general changes in the hepato-renal systems?

Answer 15

• • Decreased GFR
• • Decreased renal/hepatic blood flow
• • Decreased creatinine clearance

Question 16

What is general changes in thermoregulatory systems?

Answer 16

• • Increased risk of hypothermia

- - Atrophy of sweat glands

Question 17

What are some of the main lab values that are unchanged?

Answer 17

• • H & H
• • WBC
• • Platelets
• • Calcium
• • Liver function (except albumin production)
• • BUN

Question 18

What are some of the main lab values that are changed?

Answer 18

• • Creatinine
• • Alkaline phosphatase
• • Urinalysis

Question 19

What is the most important pre-operative assessment?

Answer 19

Functional status

Question 20

What are the greatest peri-operative risk in geriatric patients?

Answer 20

• • > 70 years old
• • Abdominal, thoracic, vascular procedures
• • Emergency operations

Question 21

What is significant risk increases for geriatric population?

Answer 21

• • Myocardial infarction within 6 months
• • Pulmonary edema
• • Unstable angina
• • Aortic stenosis

Question 22

What is the optimal choice in anesthetic for geriatric population?

Answer 22

Local anesthesia without sedation

Question 23

Just remember when dealing with the oldies

Answer 23

• • There is no ideal anesthetic

- - A good pre-op assessment is a must