Geriatric anesthesia

Question 1

What is considered a geriatric patient

Answer 1

A Geriatric patient is considered to have reached 80% of the anticipated life span
Geriatrics:
Dogs >8 years
Cats >12 years
Age is not a disease
With age there is a decrease in organ function and reserves
Age-related concurrent diseases increase the anesthetic risk
Geriatrics tend to have chronic systemic diseases that affect how anesthesia should be managed

Question 2

Physiologic Changes in Geriatrics Cardiac Diseases

Answer 2

Most common non-congenital heart disease in dogs is Mitral Valve dysfunction (Endocardiosis)
Most common non-congenital heart disease in cats is Hypertrophic Cardiomyopathy (HCM)
Reduced cardiac reserves, patients are unable to compensate for anesthetic induced hypotension
Hypotension treatment can be very different depending on the type of heart disease present

Question 3

Cardiac Disease Considerations

Answer 3

Thorough heart work-up will help to adjust anesthetic medication according to type of disease present
It is not always what you think
Pre-oxygenate and provide oxygen in recovery
Avoid fluid overload
Avoid stress, excitement, pain (catecholamine release)

Question 4

How does the resp system change in geriatrics

Answer 4

Weakened respiratory muscles
Increased fibrosis of the lungs
Decrease ability to compensate when stressed
Hypoxemia during induction and recovery
Pre-oxygenate and supply O2 in the recovery period
Manual or mechanical ventilation should be anticipated

Question 5

How does organ function change in geriatrics

Answer 5

Decreased renal and hepatic function, variable patient to patient
Pre-anesthetic bloodwork essential for organ screening
Liver and Kidneys vital to drug metabolism and elimination
Decreased function = decreased drug metabolism

Question 6

How does the GIT change in geriatrics

Answer 6

Decreased laryngeal/pharyngeal reflexes
Decreased lower esophageal sphincter tone
Lower gastric pH
More prone to esophagitis and regurgitation with anesthetic

Question 7

How does the CNS change with geratrics

Answer 7

Loss of senses (Blind, Deaf)
Decreased cognitive function
Senility
The results of age relate degradation:
Increased anxiety
Increased risk of emergence delirium
Increased risk of dysphoria due to anesthetic drugs

Question 8

Anesthetic Considerations for Geriatrics

Answer 8

Gentle handling, minimize patient stress
Pre-oxygenate and supple oxygen post-operatively
IV fluids adjusted accorded to concurrent diseases
May need to provide manual or mechanical ventilation
Monitor closely for hypothermia
Take care when positioning geriatrics (Arthritis?)
Manage blood pressure aggressively (MAP >80 mmHg)
Anticipate a long and dysphoric recovery

Question 9

Anesthetic Drug Considerations for geratrics

Answer 9

Any current medication that will compound effects of sedatives?
Use short-acting, easily eliminated drugs
When using sedatives, use the low end of the dose range
Use co-induction agents when possible, to minimize hypotension during induction (ex. Midazolam/Alfaxalone)