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P&P Spring 2020 > Exam 1 Anesthesia for Elderly > Flashcards

Exam 1 Anesthesia for Elderly Flashcards

1
Q

Anesthetic risk increased d/t 2 factors

A
  1. increased prevalence of age-related concomitant disease

2. decrease in basic organ fxn

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2
Q

____ age is more important than _____ age

A

physiologic age is more important than chronological age

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3
Q

Geriatric anesthesia

A

65 years and +

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4
Q

Multiple coexisting diseases are the ____ not the ____

A

rule, not the exception

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5
Q

Leading list of concomitant disease

A

HTN, atherosclerosis, renal dx

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6
Q

CVS system effects - patho of aging

A

CO decreases 1%/year after 30y/o
Decreased: Adenoreceptor sensitivity, Cardiac reserve, HR/coronary flow/response to stress
PVR/SBP increase

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7
Q

Nervous system effects - patho of aging

A

increased incidence of: postop confusion, delirium, sensitivity to anesthetic agents
Loss of neuronal substance + reduction in neuronal density
Regional decrease in neurotransmitters

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8
Q

Postop delirium - strategies to reduce incidence

A
  • Periop monitoring (ICU/monitored bed)
  • avoid hypoxemia, hypotension
  • correct fluid/electrolytes
  • use VAs w/ low blood/gas + tissue/blood solubility coefficients
  • AVOID anticholinergics!!!
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9
Q

POD

A

Postop delirium

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10
Q

Ventilatory system effects - patho of aging

A

Decreased: static lung volume, max exp flow, pulm static recoil, sensititvity to airway receptors, protective airway ability, baseline PaO2
Increased: A-a gradient + VQ mismatch
Less able to protect airway, clear secretions: aspiration/postop atelectasis

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11
Q

Liver changes - patho of aging

A

metabolism hindered (oxidation, glucuronidation) - increased DOA for lipid Rx

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12
Q

> 65 y/o, what change occurs to liver?

A

Liver blood flow decreases by 40%

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13
Q

Renal changes - patho of aging

A

renal clearance reduced, distal tubule fxn impaired

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14
Q

Serum creatinine

A

Remains normal d/t reduced renal excretion + less skeletal muscle mass
(creat. clearance = more accurate)

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15
Q

Maintain UOP at ____

A

0.5 mL/kg/hr to protect kidney fxn

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16
Q

Give _____ to elderly, what can happen?

A

Propofol - increased DOA

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17
Q

Effect of aging on renal blood flow + GFR

A

decline 1.5% per year

18
Q

Why are lipid drugs prolonged in elderly?

A

intracellular H2O decreases with age + increase 10% body fat

19
Q

Avoid _____ in Lewy Body Dementia

A

haldol

20
Q

Elderly have _____ volume of distribution

A

increased

21
Q

Opioids: reduce by ____

A

50%

22
Q

autonomic changes

A

dysautonomia of aging

23
Q

Elderly patients have a _____ threshold of _____

A

higher threshold of pain
(d/t decreased myelinated fibers)
*delayed recognition of painful conditions

24
Q

Fluid of choice with elderly

A

LR

kidneys not able to handle salt/water load

25
Q

high cardiac risk surgery

A
  • aortic + major vascular (peripheral arterial)

- risk of cardiac death or nonfatal MI > 5%

26
Q

intermediate cardiac risk surgery

A
  • carotid endartectomy, head/neck, intraperitoneal/intrathoracic, orthopedic, prostate surgery
  • risk of cardiac death or nonfatal MI 1-5%
27
Q

Low cardiac risk surgery

A

ambulatory, endoscopic, cataract, breast surgery

< 1% risk of cardiac death or nonfatal MI

28
Q

Risk of Alzheimers > 85 y/o

A

32%

29
Q

Dementia patients may be on

A 
cholinesterase inhibitors 
(donepezil, rivatsigmine, galantamine)
30
Q

Risk of patients on cholinesterase inhibitor

A

reduce plasma cholinesterase

  • SCh prolonged DOA
  • anticholinergic (neostigmine) = unpredictable response
31
Q

NMBA preferred in elderly

A

cis/atracurium

*ester hydrolysis/hoffmann degradation

32
Q

Effect of scopolamine, diphenhydramie, meperidine on elderly

A

decrease in cholinergic receptor activity enhances side effects of these anticholinergic agents

33
Q

DOC - volatile anesthetic

A

desflurane

*low solubility, rapid emergence from anesthesia

34
Q

Monitor for _____ if giving Desflurane to elderly

A

Tachy

HTN

35
Q

MAC ______ with age

A

decreases linearly

36
Q

Dose of all IAs should ______ % per decade > 40 y/o

A

6% per decade over 40

37
Q

Postop: age is not associated with _____ complications

A

CVS

*every other system, age IS a risk

38
Q

Up to ____ % of patients who develop POD never return to preop state

A

40%

39
Q

Risk of stroke in elderly after anesthesia

A

< 0.5%

40
Q

ABCs of anesthetic plan for elderly patient

A

A: assess
B: balance risk/benefit
C: Compensate

41
Q

hospital readmission is higher in patients > ____ y/o

A

> 80 y/o

42
Q

Useful predictor for perioperative outcomes in older adult

A

frailty

P&P Spring 2020 (6 decks)

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