Geriatric Anesthesia Flashcards
What percent of the population will be over 65 by 2040?
24%
Describe decreased CV changes in the elderly?
- Decrease in elasticity of arteries
- Decreased HR both rest and max
- Decreased baroreceptor response
- Decreased adrenergic activity
Describe increased/augmented CV changes in the elderly?
- Increased afterload
- Increased systolic pressures
- Hypertrophy of LV
What are the 5 common H&P diagnoses related to CV?
- Aortic stenosis
- History of arrhythmias
- CAD
- HTN
- CHF
Why does the elderly patient’s HR decrease with age? and what else does this lead to?
Conduction system fibrosis and loss of SA node cells.
Leads to increase chances of arrhythmias
By how much does the elderly’s HR change with age?
Decrease by 1 BPM/year after age 50
Concentric/Eccentric: Typically the heart’s response to chronic pressure overload?
Concentric
Concentric/Eccentric: Maintaining normal sarcomere lengths, while ventricular dilation occurs.
Eccentric
Concentric/Eccentric: New sarcomeres are added in-parallel to existing sarcomeres?
Concentric
T/F: Circulation time in the elderly will slow inhalation agents, and speeds up IV induction drugs?
False; Circulation time will slow IV drug induction, but speed up inhalation agent induction.
What two cardiovascular responses are altered with blunted B-receptor response?
Decreased maximal HR and decreased peak ejection fraction
T/F: The elderly patient is more dependent on an increase in HR than an increase in end-diastolic volume to increase CO?
False; Elderly patient is more dependent on an increase in end-diastolic volume.
Which respiratory changes are decreased in the elderly patient?
- Decreased elasticity of the lungs
- Decreased alveolar surface area
- Decreased cough
- Decreased max breathing capacity
- Decrease in total lung capacity
- Decrease in Vital Capacity
- Decreased response to hypercapnia/hypoxia
Which respiratory changes are increased in the elderly patient?
- Increased residual volume
- Increased chest wall rigidity
- Increased vent/perf mismatch
- Increased closing capacity/closing volume
- Increased FRC
- Increased deadspace
T/F: Elderly have signs of both restrictive and obstructive respiratory disease?
True
How much does vital capacity change with age?
Vital capacity decreases 25ml/year after age 20.
What happens to Vd/Vt ratio with age?
It increases (dead space increases) and Vt stays the same
What happens to gastric pH with age?
pH increases
T/F: Elderly patients have slower gastric emptying, but larger stomachs?
False; slower gastric emptying, but smaller stomachs.
What changes occur in the elderly in regards to heat production/conservation?
Heat production decreases and loss increases.
What three things put the elderly at risk for hypothermia?
- Decreased metabolic rate
- Decreased heat production
- Deficient thermostat control.
What 3 substances are the kidneys impaired with handling in the elderly patient?
- Impaired Na+ handling
- Impaired fluid handling
- Impaired K+ excretion
Overall, what changes can be seen in the elderly in relation to the kidneys?
Decreased blood flow, GFR, renal mass, drug excretion, etc.
What happens to the elderly patient’s creatinine and why?
Stays the same d/t decreased muscle mass=decreased creatinine production.
How does BUN change with age?
Increases 0.2mg/dl/year.
Are the elderly at a decreased risk of acute renal failure related to hypotension?
No, increased risk. Treat aggressively.
What is the most specific test of renal failure?
Serum Creatinine clearance (24hrs) to assess GFR
T/F: Elderly patients have an increased sensation to touch/temp/pain?
False; increased threshhold=decreased sensation.
Should dosages of local anesthetics be increased or decreased in the elderly?
Decreased
Do epidural anesthetics tend to have a more cephalad or caudal spread in the elderly?
Cephalad
What things can be related to the elderly’s confusion/delirium?
- Drug effects
- Pain
- Previous dementia
- Hypoxemia
- Metabolic disturbances.
T/F: Must use larger doses of anticholinergics in elderly?
False; The elderly are very sensitive to drugs like scopolamine and atropine.
PK or PD: Relationship between drug dose and plasma concentrations?
Pharmacokinetics.
What is pharmacodynamics?
Relationship between plasma concentrations and clinical effect.
Do elderly have increased or decrease muscle mass? Body fat? Total body water?
Muscle mass=decreased
Body fat=Increased
Total Body Water=decreased
Due to the decreased total body water percentage, does this lead to higher or lower plasma concentrations of water soluble drugs?
Higher concentrations
Do fat soluble drugs have a lower or higher plasma concentration in the elderly?
Lower plasma concentrations.
How does MAC change based on age?
Decrease 4% per decade after age 40
T/F: Myocardial depressants effect and tachy response are both exaggerated in the elderly?
False; Myocardial depressants are exaggerated while the tachy response is decreased (may not see big HR changes with pain in the elderly).
T/F: There is no change in NMBA effects or duration of action in the elderly?
False; No change in effects, but does prolong duration
While albumin levels are slightly decreased, what other plasma protein is increased in the elderly?
Alpha 1 Glycoprotein (AAG).
What medications bind to Alpha 1 Glycoprotein?
Local anesthetics and opioids.
What is the syndrome associated with Progeria?
Hutchinson-Gilford Syndrome.
At what age is progeria typically diagnosed?
After 6 months of age.
What are four issues patients with progeria have that can affect the airway?
- Osteoarthritis
- Micrognathia
- Narrow glottic opening
- Mandibular hypoplasia.
