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The BIG Test > Geriatric > Flashcards

Geriatric Flashcards

1
Q

What % of individuals older than 65 years are estimated to have a surgical procedure?

A

50%

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2
Q

What is a greater determinant of post-op complications than anesthetic management?

A

Pre-op co-morbid disease

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3
Q

Surgical risk and outcome in patients older than 65 years depend on what 4 factors?

A
  1. Age
  2. Status and coexisting disease
  3. Elective or emergent
  4. Type of procedure
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4
Q

A __% decline per year in organ function occurs after age ___.

A

1%

30

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5
Q

Protein catabolism + nutritional deficiencies are associated with…

A

Reduction in INTRAcellular water

Decreased K levels

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6
Q

Hypothermia is more pronounced and lasts longer due to…

A

Lower metabolic rate
Hypothyroidism
Higher ratio of body surface area to body mass
Less effective vasoconstriction

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7
Q

Cardiovascular Changes in the Elderly

Parameters that are INCREASED

A 
LV wall thickness/LVH/LV wall tension 
Afterload/Cardiac workload 
SBP/PP/PVR 
Circulation time 
Conduction fibrosis/Incidence of dysrhythmias/SA node cell loss 
Vagal tone
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8
Q

Cardiovascular Changes in the Elderly

Parameters that are DECREASED

A 
LV compliance 
Cardiac reserve
CO/CI
SV
Resting HR 
Sensitivity of adrenergic receptors 
Chronotropic and ionotropic responses 
Baroreceptor function 
Arterial compliance 
Perfusion to vital organs
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9
Q

Does the heart atrophy with age?

A

NO

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10
Q

How are short-term demands for increased CO met?

A

First modest increases in HR

Then increases in LVEDV to increase SV

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11
Q

Cardiovascular Changes in the Elderly

Parameters that are UNCHANGED

A 
DBP
Resting systolic function 
Excitation-contraction coupling 
Ionized calcium levels
Contractile proteins
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12
Q

Cardiac function declines by ___% (20-80 years old)/

A

50%

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13
Q

Respiratory Changes in the Elderly

Parameters that are INCREASED

A 
Vocal cord stimulation needed for closure - risk of aspiration/airway obstruction 
Pulmonary complications 
WOB 
Chest wall rigidity
AP diameter of chest 
Airway resistance 
Alveolar compliance 
Physiologic dead space (VD)/shunt 
V/Q mismatch 
A-a O2 (FiO2 (age + 2.5)) and CO2 gradient
Alveolocapillary membrane thickness 
Potential for hypoxia 
Respiratory depression to opioids 
Air trapping 
FRC 
CV
CC
RV
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14
Q

Respiratory Changes in the Elderly

Parameters that are DECREASED

A 
Laryngeal reflexes/protective reflexes 
Ability to cough 
Muscle strength 
Chest wall compliance 
Elasticity of lung tissues
Lung recoil 
Normal oxygen tension (PaO2) 
Efficacy of gas exchange 
Total alveolar surface area (30%) 
Response to hypoxia and hypercapnia 
Cervical spine/TMJ mobility 
East of mask ventilation 
IC
VC
ERV
IRV 
FEV1
FVC
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15
Q

What respiratory parameters change minimally with aging?

A

TLC
PaCO2
PAO2
*TLC declines about 10% by age 70 - reflecting a loss in height d/t deterioration of intervertebral disks

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16
Q

Explain the significance of the following: CC is > FRC in anesthetized elderly patients.

A

More dependent airways are collapsed and more of the TV is distributed to areas of the lung that are under perfused.

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17
Q

Endocrine Changes in the Elderly

Parameters that are INCREASED

A

Insulin resistance - DM

Heat loss

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18
Q

Endocrine Changes in the Elderly

Parameters that are DECREASED

A 
Metabolism of benzos - MEN
Synthesized plasma cholinesterases - MEN
Pancreatic function
Insulin response 
Basal and maximal O2 consumption (loss of lean body mass) 
Hypothalamic temp regulation 
Heat production
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19
Q

GI and Hepatobiliary Changes in the Elderly

Parameters that are INCREASED

A

Gastric pH

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20
Q

GI and Hepatobiliary Changes in the Elderly

Parameters that are DECREASED

A 
Liver metabolism 
Liver mass 
Liver function/Biotransformation 
Hepatic blood flow 
Albumin production 
Gastric emptying
21
Q

Nervous System Changes in the Elderly

Parameters that are INCREASED

A 
Skeletal muscle atrophy
Degeneration of peripheral nerve cells 
Proprioception, touch, temp threshold
Hearing, vision threshold
CSF 
Cerebral cortex neuron loss
Spinal DOA
Sensory block with spinals 
Epidural volume cephalad spread
22
Q

Nervous System Changes in the Elderly

Parameters that are DECREASED

A 
CBF (20%) 
Intracranial volume 
Gray matter 
Brain mass (30%)
CNS activity 
Cerebral metabolic O2 consumption 
NT receptors 
NT synthesis 
Skeletal muscle steadiness, strength, control
Nerve conduction velocity
23
Q

What dermatome level for TURPS?

A

T8

24
Q

Regional Anesthesia in the Elderly

A

Spinal
Increased DOA
Increased sensory block

Epidural 
Decreased DOA
Decreased motor block 
Decreased segment dosing 
Increased epidural volume cephalad spread

*Decreased dose for locals

25
Q

Where is neuronal loss prominent?

A

Cerebral cortex

Esp. frontal lobes

26
Q

Is cerebral autoregulation of blood flow preserved?

A

Yes

27
Q

Renal System Changes in the Elderly

Parameters that are INCREASED

A

BUN
ADH response to hypertonic saline load
Ability to develop hypo/hyperkalemia

28
Q

Renal System Changes in the Elderly

Parameters that are DECREASED

A 
Kidney mass (cortex) 
RBF (10% per decade) 
Renal plasma flow 
Renal function 
GFR (8% per decade) 
Creatinine production and clearance 
Fluid and sodium handling 
Concentrating ability 
Response to ADH and aldosterone
29
Q

Renal System Changes in the Elderly

Parameters that are UNCHANGED

A

Serum creatinine level

Decreased muscle mass and reduced creatinine production

30
Q

What is the most sensitive indicator of renal function in the elderly?

A

Creatinine clearance

*Decreases with age - 70 mL/min in 70 yo

31
Q

Pharmacology Changes in the Elderly

Parameters that are INCREASED

A

Lipid storage sites - Vd for lipid soluble drugs
Circulation time - delayed onset of drug effects
Recovery from volatile anesthetics
Alpha-1 glycoprotein

32
Q

Pharmacology Changes in the Elderly

Parameters that are DECREASED

A

Dose for GA - MAC (6% per decade over 40)
Total body water - Vd for water soluble drugs
Vascular volume - high initial plasma concentration
Albumin production
Liver metabolism
Metabolism of benzos - MEN
Plasma cholinesterases - MEN
Doses of barbs, opioid antagonists, and benzos

33
Q

Pharmacology Changes in the Elderly

Parameters that are UNCHANGED

A

Extracellular fluid volume
Plasma volume
Red cell mass
Response to muscle relaxants (NDMR and Sux)

34
Q

Recovery from anesthesia with volatile anesthetics may be prolonged b/c of an…

A

Increased Vd
Decreased hepatic function
Decreased pulmonary gas exchange

35
Q

Drug Dose Adjustments for 80 yo

A 
Propofol: 1.7 mg/kg 
Midazolam: 0.02-0.03 mg/kg 
Etomidate: 0.2 mg/kg 
Opioids: reduce by 50% 
Sux: slightly reduce dose in men
MR: slower onset, decreased maintenance doses, increased DOA 
Atropine: increase dose 
Beta agonists: increase dose
36
Q

Sux is prolonged in combo with what other drug?

A

Metoclopramide

37
Q

The geriatric patient needs special attention while positioning. Which join is most vulnerable?

A

Neck

38
Q

The onset of MR is prolonged because of…

A

Low muscle blood flow

39
Q

In general are most plasma protein levels increased, decrease, or unchanged?

A 
Most levels are unchanged 
Albumin is decreased 
(binds with acidic drugs - barbs, propofol) 
Alpha-1 glycoprotein is increased 
(binds with basic drugs - LA, opioids)
40
Q

FRC vs. CC
44 yo in supine position
66 yo in upright position

A

44 yo in supine position: CC = FRC

66 yo in upright position: CC = OR > FRC

41
Q

Closing volume is ___% of vital capacity in the young and increases to about ___% of vital capacity in the elderly.

A

10%

40%

42
Q

How can PaO2 be estimated for a given age?

A

102-(Age/3)

43
Q

What 2 important changes in the autonomic NS take place with aging?

A
  1. Decrease in response to B receptor stimulation

2. Increase in SNS activity

44
Q

What organ systems are of greatest concern in the post-op period?

A

Cardiac

Respiratory

45
Q

Is an IV induction slower or faster in the elderly? Inhalational induction?

A

IV induction is slower

Inhalational induction is faster

46
Q

After what type of surgery is post-op delirium most common in the elderly?

A

Orthopedic

*Interval delirium is most common

47
Q

There is a decreased response to both ____ adrenergic receptor agonist and adrenergic receptor antagonists.

A

BETA

48
Q

What are the 2 leading causes of death in the elderly trauma patient?

A
  1. Respiratory failure

2. Sepsis

The BIG Test (21 decks)

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