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Patient Assessment II Exam 1 > Geriatric Anesthesia > Flashcards

Geriatric Anesthesia Flashcards

1
Q

The geriatric demographic is typically defined as

A

chronological age > 65

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2
Q

By 2040, geriatrics are estimated to make up what % of the population

A

24%

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3
Q

What % of the population do geriatrics make up now

A

~12% (fastest growing age group)

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4
Q

Geriatrics account for what percent of healthcare expenditures

A

50%

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5
Q

% of geriatrics that require surgery before they die

A

50%

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6
Q

Currently, what % of all procedures are performed on elderly

A

35%

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7
Q

Risk of preoperative death in elderly

A

3x more likely

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8
Q

Geriatric effect on arteries

A

stiffen with age (naturally)

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9
Q

What does stiffening of arteries do to afterload?

A

Increase

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10
Q

What does stiffening of arteries do to systolic blood pressure?

A

increases

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11
Q

What does stiffening of arteries do to left ventricular hypertrophy

A

increases

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12
Q

Geriatric/aging effect on cardiovascular function

A
  • stiff arteries
  • myocardial fibrosis, valve calcification
  • Increase vagal tone
  • increased risk of dysrhythmias
  • higher incidence of diastolic dysfunction
  • decreased cardiac reserve
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13
Q

Geriatric/aging effect on vagal tone

A

increases (decreasing HR, decreasing sensitivity to adrenergic drugs; decreased natural response to hypovolemia)

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14
Q

Main dysrhythmias associated with geriatric cardiac function

A

A-fib/flutter

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15
Q

Geriatric effect on cardiac reserve

A

Decreases (predisposes pt to labile bp, longer circulation time for meds)

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16
Q

Cardiac disease states most common in elderly (5)

A 
HTN 
CAD
CHF
PVD (peripheral vascular disease) 
anemia
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17
Q

Things you should do to assess cardiac function in elderly before surgery

A
  • ECG indicated most of the time
  • current medications related to heart (bb? warfarin? Ca channel blockers?)
  • review/ask about cardiac testing (ECG, echo, stress)
  • auscultate each valve
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18
Q

What are some drugs you should ask an elderly patient if they take if you’re concerned about the heart?

A

beta blockers
warfarin
Ca channel blocker

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19
Q

What are some tests you should review/interrogate about if you’re concerned with cardiac function?

A

ECG, echo, stress tests

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20
Q

Geriatric effect on pulmonary function

A
  • decreased elasticity in lung tissue
  • age-associated kyphoscoliosis
  • anatomic/physiological dead space increase
  • blunted response to hypercapnia and hypoxia
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21
Q

Geriatric effect on lung tissue elasticity

A

decreased

- alveolar collapse/distension common (atelectasis)

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22
Q

% reduction in alveolar surface area by 70

A

15%

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23
Q

Aging effect on spine

A

can get kyphoscoliosis leading to decreased chest height, altering respiratory mechanics

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24
Q

Aging effect on anatomic/physiologic deadspace

A

increase

  • due to increase in central airway size
  • small airways decrease in diameter from connective tissue loss
  • airway resistance remains unchanged
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25
Q

Aging effect on the response to hypercapnia or hypoxia

A

blunted

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26
Q

Aging effect on central airway size? Small airway size?

A

increases central airway size
decreases small airways (connective tissue loss)
- increasing deadspace

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27
Q

Aging effect on total airway resistance

A

unchanged

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28
Q

What should you ask an elderly patient about when assessing pulmonary function?

A
  • breathing issues, recent coughs/fevers, etc
    • auscultate both apex and base of each lung (fluid will be at bottom)
  • PFTs helpful if dz present (consider FiO2, Vt, PIP, PEEP)
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29
Q

GOLD acronym

A

global initiative for chronic obstructive lung disease

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30
Q

GOLD 1 classification of COPD

A

Mild
FEV1 >/= 80% predicted
FEV1/FVC <0.7

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31
Q

GOLD 2 classification of COPD

A

Moderate
50% = FEV1 < 80% predicted
FEV1/FVC < 0.7

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32
Q

GOLD 3 classification of COPD

A

severe
30% = FEV1 < 50% predicted
FEV1/FVC < 0.7

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33
Q

GOLD 4 classification of COPD

A

Very severe
FEV1 < 30% predicted
FEV1/FVC <0.7

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34
Q

Metabolic and endocrine effect from aging

A
  • basal/max oxygen consumption decrease
  • weight loss
  • heat production decrease, loss increase
  • insulin resistance increase
  • stress response preserved
  • renin and aldosterone decline
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35
Q

Aging effect on basal/max oxygen consumption

A

decreases; metabolic decreases creates hypothermia risk

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36
Q

Weight loss begins after what age

A

60

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37
Q

Heat production/loss effect from aging (why might this be?)

A

heat production decreases, loss increases

- hypothalamus function decreases

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38
Q

Aging effect on insulin resistance? Why does this matter?

A

increases; diabetes is more likely to occur

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39
Q

Aging effect on stress response

A

fairly preserved

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40
Q

Aging effect on hormones

A 
Renin and aldosterone decline 
others unchanged (ACH, cortisol, TSH, thyroxine)
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41
Q

Drug to avoid with diabetics

A

decadron (GC steroid)

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42
Q

What should you assess for endocrine function?

A

Diabetes (glucose tests)

TSH/thyroxine levels if thyroid disease present

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43
Q

What drug will patients be on for hypothyroidism?

A

levothyroxine

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44
Q

A1C (percent) for non-diabetic patient

A

about 5

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45
Q

A1C (percent) for prediabetic patient

A

5.7 to 6.4

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46
Q

A1C (percent) for diabetic patient

A

6.5 or above

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47
Q

Fasting plasma glucose concentration for non-diabetic patient

A

99 or below

48
Q

Fasting plasma glucose concentration for pre-diabetic patient

A

100-125 mg/dL

49
Q

Fasting plasma glucose concentration for diabetic patient

A

126 or above

50
Q

Oral glucose tolerance test for non-diabetic patient

A

139 or below

51
Q

Oral glucose tolerance test for pre-diabetic patient

A

140-199 mg/dL

52
Q

Oral glucose tolerance test for diabetic patient

A

200 or above

53
Q

Aging effect on kidney mass

A

decreases

54
Q

What percent of function glomeruli do kidneys lose by age 80? GFR?

A

50% for both

blood flow decreases as well

55
Q

Aging effect on ability to dilute/concentrate urine and conserve sodium

A

decreases

56
Q

Aging effect on renal function

A
  • kidney mass decrease
  • increase risk of ARF
  • prone to electrolyte imbalance
  • creatinine unchanged
57
Q

Why are geriatric patients more prone to electrolyte imbalances

A

side effects from medications especially if on a diuretic for HTN
- more predisposed to dehydration or fluid overload

58
Q

Why is creatinine unchanged in geriatric patients?

A

loss in muscle; but BUN increases (blood urea nitrogen)

59
Q

What tests should you do to assess renal function?

A
  • GFR, creatinine, BUN

- electrolyte imbalances (could cancel case like if hypokalemic)

60
Q

Normal GFR

A

60-120

61
Q

Kidney disease GFR

A

59-15

62
Q

Kidney failure GFR

A

14-0

63
Q

Elderly effect on GI function

A
  • liver mass decrease
  • Gastric pH rise
  • prolonged gastric emptying but lower volumes
  • swallowing/esophageal motility maintained if healthy (but more prone to developing dz state)
64
Q

How much does liver mass decrease by age 80?

A

40%

65
Q

Elderly effect on hepatic blood flow? Why is this important?

A

decreases, this is important because of metabolism of certain drugs

66
Q

Aging effect on liver function tests and liver enzymes?

A

normal

67
Q

How should you assess GI function in a geriatric patient?

A

Liver function tests

EGD/colonoscopy charts (Esophagogastroduodenoscopy)

68
Q

Where produced: Alanine transaminase

What does it measure?

A

liver

Measures level of ALT in blood; can be sign of liver damage

69
Q

Where produced: Aspartate transaminase

What does it measure?

A

large amount in liver and other parts of body; measures AST in blood and high levels can be sign of liver damage

70
Q

Where produced: alkaline phosphatase

What does it measure?

A

large amounts found in liver, bile ducts, and other parts

ALP test measures ALP in your blood; high levels can be sign of liver or bile duct damage

71
Q

Where produced: gamma-glutamyl transpeptidase

What does it measure?

A

large amount found in liver, bile ducts, and pancreas. GGT test measure GGT in blood and high levels can be sign of liver or bile duct damage

72
Q

What does total protein tests measure?

A

protein in blood; mainly globulins and albumin

73
Q

Where produced: albumin

What does it measure?

A

Made in liver; albumin tests measure how well your liver makes proteins your body needs. Low levels can be sign of liver damage

74
Q

Where produced: prothrombin

What does it measure?

A

made in liver and helps with clotting blood. PTT (prothrombin time) tests how long it takes your blood to clot. High prothrombin can mean liver damage

75
Q

Where produced: bilirubin

What does it measure?

A

yellow fluid made when RBCs break down. Measure bilirubin in blood. If liver is damaged, bilirubin will leak out into blood and cause jaundice and make your urine look dark

76
Q

Liver protein tests

A

total protein, albumin, prothrombin

77
Q

What does globulin do? Where is it made? What happens if it is low?

A

made in liver; helps immune system fight infections

low levels can be sign of liver failure or other

78
Q

Normal creatinine range

A

80-132

79
Q

Normal total protein range

A

64-82

80
Q

Normal albumin range

A

35-50

81
Q

Normal globulin range

A

23-35

82
Q

Normal bilirubin range

A

3-17

83
Q

Normal alkaline phosphatase range

A

50-136

84
Q

Normal Alanine transaminase (ALT) range

A

12-78

85
Q

Normal Aspartate transaminase (AST) range

A

15-37

86
Q

Normal gamma-glutamyl transpeptidase range

A

15-85

87
Q

What percent does brain mass decrease by age 80? From what?

A

30% from neuronal loss/shrinking in cerebral cortex

88
Q

What percent does cerebral blood flow decrease in elderly?

A

10-20%

89
Q

Aging effect on cerebral auto regulation

A

still functional

90
Q

Aging effect on neurotransmitter (and associated receptor) production

A

decrease

91
Q

Aging effect on peripheral nerves; what does this cause?

A

degenerates

- causes muscle atrophy and increased sense threshold (so less narcotics because less pain felt)

92
Q

Aging effect on cognitive function

A

mostly normal if no disease but pt still at higher risk for post-op delirium

93
Q

Neurological assessment on elderly patient

A

interviewing patient helps a lot
- alzheimers, parkinsons, dementia
family members also help with how advanced disease is

94
Q

If your patient has Alzheimer’s, Parkinson’s, Dementia what drugs should you consider holding?

A

benzodiazepines because they can interfere with levodopa treatment that must be maintained. Also consider minimum required amnestic agents

95
Q

Aging effect on musculoskeletal

A
  • overall less muscle mass
  • skin atrophies and prone to trauma
  • arthritic joints can make positioning, intubation, regional/neuraxial anesthesia difficult
  • weak respiratory muscles
96
Q

Considerations if your elderly patient has skin atrophies and is prone to trauma?

A

Cautious with tape, Bovie pads, ECD pads

  • try to use paper tape
  • be careful with IVs (veins prone to rupture)
97
Q

Aging effect on laryngeal reflexes

A

decreased; aspiration pneumonia much more common

98
Q

How should you assess musculoskeletal function in an elderly patient?

A
  • take a good look at them and how frail they look
  • ask pt about exercise tolerance
  • ask about arthritis and osteoporosis
99
Q

Pharmacological effects of water-soluble drugs on an elderly patient

A

since they overall have less body water there is a reduces distribution volume. leads to high plasma concentration

100
Q

Pharmacological effects of fat-soluble drugs on an elderly patient

A

increased distribution volume because adipose tissue is more prominent and muscle less so; causing lower plasma concentration

101
Q

What happens to elimination half life if distribution volume increases?

A

elimination half life with also increase unless clearance rate also increases BUT renal and hepatic function decreases as well

102
Q

MAC requirements per decade past 40

A

decreases by 4% (so decreases 8% by 60)

103
Q

Myocardial depression effects effect on elderly and how this might effect inhalation agent onset

A

exacerbated, and may lead to decreased CO causing faster onset time

104
Q

Why high emergence/recovery time be prolonged in elderly?

A

fat; weak respiratory efforts

105
Q

IV medications for elderly

A

use lower doses for propofol, etomidate, barbiturates, opioids, benzodiazepines

106
Q

Propofol dose for elderly versus 20 year old

A

elderly may require half the induction dose of propofol

107
Q

How come you don’t need to decrease ketamine for elderly patients?

A

it’s water and fat soluble

108
Q

Reduction of fentanyl for elderly patient

A

up to 50%

109
Q

Reduction of versed for elderly patient

A

up to 50%

110
Q

Onset of a non-depolarizing NMBD in an elderly patient? Recovery?

A

2X longer onset with delayed recovery due to decreased liver and renal function

111
Q

Onset of a depolarizing NMBD for an elderly patient

A

unchanged since sux uses something else but elderly mean may have lower plasma cholinesterase levels, slightly prolonging sux

112
Q

Degradation of organ system is dependent on

A

genetics, environment and diet

113
Q

What types of medications should you lean towards with an elderly patient?

A

short acting and avoiding renal/hepatic elimination drugs

114
Q

Elderly recovery from GA

A

they take longer and are more likely to experience post-op delirium

115
Q

Intraoperative awareness in elderly

A

more likely because of lower medications

Patient Assessment II Exam 1 (3 decks)

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