Geri Rupp Flashcards
Geriatric population ___ fold increase of intra-op death
3
Elevated CV changes in geri
Elevated afterload,
elevated systolic pressure,
Left ventricular hypertrophy
Decreased CV changes
decrease in elasticity of arteries,
adrenergic activity decreases,
decreased heart rate both rest and max,
decreased baroreceptor response
Commonly on H&P
Aortic stenosis, Hx of arrhythmias, CHF, HTN, CAD
Heart rate declines __ _____ per minute per year over the age of ____
1 beat,
50
_____ enlargement puts them at risk for ____ and very common A-____
Atrial,
SVT,
A-fib
COnduction system fibroses and loss of ___ node cells increase chances of _____
SA node,
arrhythmias
Left ventricular wall ______ by _____ the cavity
thickens,
decreasing
Eccentric hypertrophy
ventricular dilation while maintaining normal sarcomere lengths-the heart can expand to receive a greater volume of blood. The wall thickness normally increases in proportion to the increase in chamber radius
Concentric hypertrophy
In the case of CHRONIC pressure overload (as through anaerobic exercise, which increases resistance to blood flow by compressing the arteries), the chamber radius may not change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres
what causes drops in BP during induction with geriatrics?
decreases in their cv system-autonomic responses that maintain homeostasis progressively decline-autonomic dysfuntion
circulation time IV vs inhalation
slow IV drugs but speeds induction with inhalation agents
What are two cardiovascular responses that are altered to blunted B-receptor response?
decreased maximal heart rate and decreased peak ejection fraction (board question)
The elderly patient is more dependent on an _____ in ___-_____ volume than an ________ in heart rate to produce an _____ in CO.
increase, end-diastolic, increase, increase. These factors make the geri patient more prone to CHF when large volumes of IV fluids are administered in the presence of anesthetic-induced myocardial depression and hypotension.
Respiratory decrease changes
decrease in elasticity of lungs,
decrease in alveolar surface area,
decreased cough,
blunted response to hypercapnia and hypoxia,
decreased max breathing capacity,
vital capacity significantly decreases-25mL/yr starting at age 20,
total lung capacity decreases
respiratory changes increase
increased residual volume, vent/perf mismatch, increased chest wall rigidity, increased closing capacity and closing volume, dead space increases, FRC increases slightly
Lung H&P
Lung CA,
Pneumonia,
Emphysema,
Chronic bronchitis
Respiratory general
see an over distention of alveoli,
collapse of small airways,
this pts difficult to mask vent-edentulous,
arthritis in mouth opening and cervical spine,
no teeth does make for a better view,
increase risk of aspiration r/t decrease in airway reflexes,
shallow breathers in recovery room-Question to leave intubated with a pre-exisiting respiratory disease.
elderly have signs of both ____ and obstructive disease
restrictive
does Vd/Vt ratio increase or decrease with age
Bohr equation, increase?
150mL/450mL=0.33%
200mL/400mL=0.5%?
Elderly gastric
gastric pH rise,
Gastric emptying slows,
Some elderly patients have smaller stomach volumes than younger patients
Temperature regulation
Heat production decreases,
Heat loss increases,
Three things that put them at risk-decreased metabolic rate, decreased heat production, deficient thermostat control
Renal changes
decreased blood flow, GFR, renal mass, concentration, dilution, drug excretion, renin-aldosterone response.
Impaired sodium handling, fluid handling, and potassium excretion
Renal H&P
Prostatic obstruction, CHF, Hypertensive nephropathy, diabetic nephropathy
BUN gradually _____ by ____ mg/dl per year
increases 0.2%
Renal cortex replaced with ____ and _____ tissue
fat and fibrotic
serum creatinine is the same r/t
decrease in muscle mass and decreased production of creatinine
Predisposed to dehydration as well as fluid overload r/t
sodium, diluting, and concentrating management changes
Inability to reabsorb glucose increases or decreases?
decreases
Decreased blood flow to renal in this pop increases their risk of
acute renal failure
Diuretics predispose them to
hyperkalemia and hypokalemia
Most specific test of renal failure
serum creatinine clearance (24hrs) to assess GFR (important)
Cerebral blood flow and brain mass
decrease
Neurotransmitters ______ (dopamine) and their receptors ________
decrease, decrease
Degeneration of peripheral nerves does what to conduction and reactions leading to muscle______
SLOWS, atrophy
Increase in thresholds
touch, temperature, pain, proprioception, hearing, and vision
Dosages for locals and general anesthetics are
reduced.
Spread of epidural
more cephalad spread
epidrual has a _____ duration on analgesia and motor
shorter
geriatrics need more____ to recover cognitively from general anesthetics
time
______ incidence of confusion, delirium, and cognitive disruptions can be related to
drug effects, pain, previous dementia, hypoxemia, and metabolic disturbances
very sensitive to anticholinergics like
scopolamine and atropine
some suffer prolonged or even permanent cognitive problems— believed
to be non anesthetic related
skin atrophies with age, prone to ______. veins frail and hard to ____. arthritic joints, make _______ difficult
tearing,
cannulate,
positioning
pharmacokinetic-
relationship between drug dose and plasma concentrations
pharmacodynamic-
relationship between plasma concentrations and clinical effect
_____ in muscle mass and _____ in body fat
Decrease, increase (more in women on body fate)
Do pharmacokinetics and pharmacodynamics changes?
Yes but research inconsistent with this population
Total body water is
decreased (effects water soluble drugs)
Reduced volume for water soluble drugs can lead to _____ plasma concentrations
HIGHER
Conversely fat soluble drugs- with _____ volume of distribution, can ____ the plasma concentrations
increased, lower
why do many drugs have prolonged effects?
d/t renal and hepatic function declining
MAC for inhalation agents decrease __% per decade after age ____
4%, 40
decreased CO causes onset to be more
rapid
myocardial depressants effect ______ while the tachy response is ______
exaggerated, decreased
Longer to wake up d/t _____ body fat, _____ hepatic, and _____ pulmonary gas exchange.
increased, decreased, decreased
doses for barbiturates, opioid agonists, and benzodiazepines
Lower
IS there a change n muscle relaxant effects?
No, but PROLONGED excretion (renal)
Most plasma proteins are unchanged, albumin slight decrease, but alpha-1 glycoprotein _____- this one binds with ____ ______ and ________
increases, binds with local anesthetics and opioids
what is progeria and what is another name for it?
premature aging, Hutchinson-Gilford syndrome
Signs of progeria
ischemic heart disease, HTN, cerebrovascular disease, osteoarthritis, and diabetes mellitus. Mandibular hypoplasia, micrognathis, narrow glottic opening
progeria apparent at what age and average lifespan?
6 months and 13 yo
Overview
choose drug doses wisely, think regional, give beta blockers, five antibiotics, avoid hypothermia, prepared for hemodynamic instability, post-op analgesia carefully, monitor for sub-clinical events, allow more time to respond to questions, requests, drugs, and time to emerge/achieve extubation criteria, Bad outcomes usually occur despite good care
