Geriatric Flashcards
Heart rate declines ___ beat per minute every year over age _____.
- 1
- 50
What causes the increase chance in arrhythmias?
- Conduction system fibrosis
- SA node cell loss
Atrial enlargement puts old people at risk for what 2 things?
- SVT
- AFib
Left ventricular wall thickens by _______ the _______
- Decreasing
- Cavity
Wall thickness increases in proportion to increase in chamber radius, this type of hypertrophy is called what?
Eccentric hypertrophy
What type of hypertrophy when chamber radius does not change while wall thickness increases?
-Concentric hypertrophy
In concentric hypertrophy, how are new sarcomeres added?
-Parallel to existing sarcomeres
Chronic pressure overload can lead to what type of hypertrophy?
Concentric
How will slowed circulation effect IV and Inhaled agents?
- Slow IV
- Speeds Inhaled agents
Autonomic responses that maintain homeostasis decline with age, this can lead to what and do what during induction?
- Autonomic dysfunction
- Drop in BP
Blunted B-receptors alter what two responses?
- Decreased HR
- Decreased ejection fraction
To increase CO, old people are more dependent on ______, rather than _______.
- End diastolic volume
- HR
Due to old peoples reliance on end diastolic volume vs. HR, this place them at greater risk of what?
-CHF from large volumes of IV fluid, with anesthesia induced myocardial depression
Name 2 elevated CV changes among old people?
- Elevated Afterload
- Elevated Systolic pressure
What 4 CV things decrease with oldies?
- Decreased elasticity of arteries
- Decreased adrenergic activity
- Decreased HR
- Decreased baroreceptor response
What 5 respiratory changes decrease with elderly?
- Decreased elasticity of lungs
- Decrease alveolar surface area
- Decreased cough
- Decrease Max breathing
- Decreased vital capicity
What 6 respiratory changes increase with elderly?
- Increased residual volume
- Increased V/Q mismatch
- Increase chest wall rigidity
- Increased closing capicity/volume
- Increased FRC
- Increased Dead space
The elderly have _______ response to hypercapnia and hypoxia
-Blunted
Elderly have over ________ of alveoli and _______ of small airways
- Distension
- Collapse
Elderly increased risk of aspiration is r/t what?
-loss of airway reflexes
Vital capacity decreases ____ mls per year starting at age ____.
- 25
- 20
does Vd/Vt ratio increase or decrease with age?
Increase
Elderly GI consideration
- pH rises
- Gastric emptying slows
- Smaller stomachs
Elderly temp considerations
- Heat production decreases
- Heat loss increases
What 3 things put elderly risk for temp loss?
- Decreased metabolic rate
- Decreased heat production
- Deficient thermostat control
What decreasing renal problems are seen w/ oldies?
- Blood flow
- GFR
- Renal Mass
- Concentration
- Dilution
- Drug excretion
- Renin-aldosterone response
What 3 renal functions are impaired with oldies?
- Sodium handling
- Fluid handling
- Potassium excretion
Renal cortex is replaced with what?
-Fat and fibrotic tissue
BUN gradually _______ 0.2 mg/dl per year
Increases
Why does serum creatinine remain the same as we age?
-decrease in muscle mass
Elderly are predisposed to what?
- Dehydration
- Fluid overload
Fluid overload in oldies is related to what?
- Sodium
- diluting
- concentrating management changes
What increases the elderly risk of acute renal failure?
-Decreased blood flow
Oldies are predisposed to hyper and hypokalemia due to what?
-Diuretics
What is the most specific test for renal failure?
-Serum creatinine clearance (24 hour urine)
What things decrease in the nervous system with the elderly?
- Cerebral blood flow
- Brain Mass
- Neurotransmitters (dopamine)
What helps preserve cognitive function?
-Physical activity
What leads to muscle atrophy?
-Degeneration of peripheral nerves which slows conduction and reactions
What nervous system threshold increase with oldies?
- Touch
- Temp
- Pain
- Proprioception
- Hearing
- Vision
Dosages for local anesthetics and general anesthetics are ______.
Reduced
Epidural anesthesia has a more ________ spread.
Cephalad
Elderly are very sensitive to anticholinergics like _________ and _______.
Scopalmine and atropine
High incidence of confusion and delirium can be related to what?
- Drugs
- Pain
- Hypoxemia
- Metabolic disturbances
- Previous dementia
What is pharmacokinetics?
-Relationship between drug and plasma concentration
What is pharmacodynamics?
-Relationship between plasma concentration and clinical effect
A decrease in muscle mas and increase in fat does what?
-Decreases total body water and effects water soluble drugs
How are fat and water soluble drugs effected on oldies?
- Water = Increased plasma concentrations
- Fat = decreased plasma concentrations
MAC for inhalation agents declines ______ per decade after age _____.
- 4%
- Age 40
Inhalation agent onset is more rapid if cardiac output is ______.
Deceased
myocardial depressant effect is ________ and tachycardia response is _________.
- Exaggerated
- Decreased
Lower doses are needed for what 3 meds?
- Barbs
- Opioid agonists
- Benzos
_____ ______ in muscle relaxant effects, but do have _________ excretion.
- No change
- Prolonged
Most plasma proteins are unchanged with elderly except what 2?
- Albumin = slight decrease
- Alpha 1 glycoprotein = increase
What plasma protein binds to local anesthetic and opioids?
-Alpha 1 glycoprotein (AAG)
Hutchinson-Gilford syndrome causes what? When is it apparent? and how long do they live?
- Premature aging
- after 6 months
- 13 years
Progeria anesthesia considerations
- Mandibular hypoplasia
- Micrognathis
- Narrow glottic opening
Elderly anesthesia tidbits.
- Give beta blockers
- give ABX
- Avoid hypothermia
- think regional
- Longer emergence / extubation time
