Geriatric Flashcards
Which type of dysfunction sees an increased onset in the elderly, diastolic or systolic? why?
diastolic; inadequate filling due to an inability to relax or because the walls have become hypertrophied [concentric - walls growing in]; systolic is maintained
What effect is seen on HR in the elderly? why?
decreased HR because of increased vagal tone and decreased sensitivity of adrenergic receptors
Describe the effect of aging on the neuroendocrine system
response to stress is preserved but there is a decreased sensitivity to beta-adrenergic agents
How does aging effect neuraxial anesthesia?
epidural - increased spread; spinal - longer duration
In what drugs should you decrease the dose requirement for the elderly?
volatiles, propofol, etomidate, barbs, opioids, benzos
What is closing capacity? what happens when it exceeds residual volume?
closing capacity - the volume at which alveoli collapse; if the alveoli collapse, it causes V/Q mismatch
How might lack of teeth pose a problem for ventilating a patient?
makes bag-masking more difficult
What effect does aging have on creatinine? BUN?
Cr - stays same (decreased muscle mass plus decreased GFR); BUN increases 0.2mg/dL/yr
How are hepatic and renal metabolism of drugs affected?
both decreased
True or false: the elderly are predisposed to both dehydration and fluid overload. If so, why?
true - decreased ability to concentrate and dilute urine
What are the effects on pH and gastric emptying in the elderly?
increased pH, slower gastric emptying
What effect does age have on recovery from volatile anesthetics?
recovery time increased
What drug doses can be decreased by up to 50% in the elderly?
propofol, fentanyl, midazolam
How does age effect NMB dose, onset and duration? why?
dose - same, delayed onset (due to decreased CO), prolonged duration (due to decreased hepatic and renal function and decreased plasma esterases [men])
How much does MAC decrease with age?
4-6% per decade after 40
