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APA 2 > Geriatric Anesthesia > Flashcards

Geriatric Anesthesia Flashcards

1
Q

**Cardiovascular changes in the elderly - _________ in elasticity of arteries

A

decreased

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2
Q

**Cardiovascular changes in the elderly - _______ afterload

A

elevated

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3
Q

**Cardiovascular changes in the elderly - ________ systolic pressures

A

elevated

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4
Q

**Cardiovascular changes in the elderly - Left ventricular ___________

A

hypertrophy

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5
Q

**Cardiovascular changes in the elderly - Adrenergic activity _________

A

decreases

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6
Q

**Cardiovascular changes in the elderly - ________ heart rate (both resting and max)

A

decreased

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7
Q

**Cardiovascular changes in the elderly - _________ baroreceptor response

A

decreased

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8
Q

**Cardiovascular history to be concerned about

A

AS, History of arrhythmias, CHF, HTN, CAD

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9
Q

Heart rate declines 2 beat per minute per year over the age ____

A

50

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10
Q

Conduction system _______ and loss of SA node cells increases chance of _________

A

fibroses / arrhythmias

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11
Q

Atrial enlargement puts them at risk for what?

A

SVT and Afib

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12
Q

Left ventricular wall thickens by decreasing the ________

A

cavity

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13
Q

What does this describe? Ventricular DILATION while maintaining normal sarcomere lengths - the heart can expand to receive a greater volume of blod. The wall thickness normally increases in proportion to the increase in chamber radius. This type of hypertrophy is termed _________ hypertrophy

A

eccentric

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14
Q

In the case of CHRONIC pressure overload (as through anaerobic exercise, which increases resistance to blood flow by compressing arteries), the chamber radius MAY NOT change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres. This is termed _______ hypertrophy

A

Concentric

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15
Q

Decrease in their cardiovascular system causes drop in BP during ________. Autonomic responses that maintain homeostasis progressively decline. This is termed _____ ____

A

induction / autonomic dysfunction

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16
Q

**Circulation time will slow ___ drugs but speeds up induction with _______ agents

A

IV / inhalation

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17
Q

The elderly patient is more dependent on an increase in _______ than increase in ______ to produce an increase in CO. These factors make the geriatric patient more prone to _____ when large volumes of IVF are administered in the presence of anesthetic induced myocardial depression and hypotension. So this makes a good case to give _______ instead of crystalloids.

A

EDV / HR / CHF / colloids

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18
Q

**Respiratory changes in the elderly - ________ in elasticity of lungs

A

decrease

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19
Q

**Respiratory changes in the elderly - _______ in alveolar surface area

A

decrease

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20
Q

**Respiratory changes in the elderly - __________ residual volume

A

increased

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21
Q

**Respiratory changes in the elderly - ________ mismatch

A

V/Q

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22
Q

**Respiratory changes in the elderly - _________ chest wall ridgity

A

increased

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23
Q

**Respiratory changes in the elderly - ________ cough

A

decreased

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24
Q

**Respiratory changes in the elderly - Blunted response to _______ and ______

A

hypercapnia and hypoxia

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25
Q

**Respiratory changes in the elderly - ________ max breathing capacity

A

decreased

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26
Q

**Respiratory changes in the elderly - ________ closing capacity and closing volume

A

increased

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27
Q

Common History and Physical items related to geriatrics and respiratory

A

Lung CA, Pneumonia, emphysema, chronic bronchitis

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28
Q

See an overall ______ of alveoli and _______ of small airways

A

distention / collapse

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29
Q

Arthritis in mouth opening and cervical spine may cause what?

A

difficult intubagtion and small mouth opening

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30
Q

The elderely have a increased risk of aspiration r/t to decrease in ______ reflexes

A

airway

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31
Q

With the elderly, FRC _______ slightly

A

increases

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32
Q

Vital capacity significantly decreases 25 ml/year starting at age ____

A

20

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33
Q

Residual volume _______ with age

A

increases

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34
Q

Total lung capacity ________ with age

A

decreases

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35
Q

Elderly have signs of both ______ and ________ disease

A

restrictive and obstructive

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36
Q

Dead space ______ in elderly

A

increases

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37
Q

**Does Vd/Vt ratio increase or decrease with age

A

increase

38
Q

Gastric changes in the elderly

A

gastric pH rises, gastric emptying slows, some elderly have smaller stomach volumes than younger patients

39
Q

Heat production ______ with age and heat loss________

A

decreases / increases

40
Q

**Three things that put elderly at risk for heat loss

A

dereased metabolic rate, decreased heat production, deficient thermostat control

41
Q

If it’s a belly surgery, make sure you have what on the OR table

A

K-pad warmer

42
Q

**What renal IMPAIRMENTS are noted with the elderly?

A

impaired sodium handling, impaired fluid handling, impaired potassium excretion

43
Q

**What is renal decreases do we see with elderly?

A

decreased blood flow, GFR, renal mass, concentration, dilution, drug excretion, renin-aldosterone response

44
Q

What might you expect renal wise on the elderly history and physical?

A

prostatic obstruction, CHF, hypertensive nephropathy, diabetic nephropathy

45
Q

Renal cortex is replaced with ____ and _____ tissue

A

fat and fibrotic

46
Q

Serum creatinine is the _____ r/t decrease in muscle mass and decreased production of creatinine

A

same

47
Q

BUN gradually INCREASES ____% mg/dl per year

A

0.2% mg/dl

48
Q

They are predisposed to _______ as well as _____ ________ r/t sodium, diluting, and conentration management changes

A

dehydration / fluid overload

49
Q

Inability to _______ glucose

A

reabsorb

50
Q

Decreased blood flow to kidneys in this population increases their risk of ____ ____ ___

A

acute renal failure

51
Q

They are predisposed to ______ and __________ with the prescription of diuretics

A

hyperkalemia and hypokalemia

52
Q

**What is the most specific test or renal failure

A

serum creatinine clearance

53
Q

Cerebral blood flow and brain mass _____ with age

A

decrease

54
Q

Neurotransmitters (dopamine) __________ and their receptors ______ as well

A

decrease / decrease

55
Q

Physical activity shows to preserve _____ function

A

cognitive

56
Q

Degeneration of peripheral nerves slows conduction and reactions which leads to muscle _______

A

atrophy

57
Q

There is ________ in thresholds to touch, temp and pain

A

increase

58
Q

Threshold ______ in proprioception, hearing and vision

A

increases

59
Q

Dosages for locals and general anesthetics are ______ in the elderly

A

reduced

60
Q

Epidural anesthetic tends to have a more _______ spread

A

cephalad

61
Q

Epidural anesthetic has a shorter duration on _____ and ______

A

analgesia and motor

62
Q

Geriatrics need more time to recover _______ from GA. Consider this when outpatient surgery is being done - do they have care system in place?

A

cognitively

63
Q

In geriatrics there is a ______ incidence of confusion, delerium and cognitive disruptions

A

higher

64
Q

What can confusion and delerium in geriatrics be related to?

A

drug effects, pain, previous dementia, hypoxemia, and metabolic disturbances

65
Q

**T/F Geriatrics are VERY sensitive to anticholinergics like scopolamine and atropine

A

TRUE

66
Q

Some suffer prolonged or even permanent cognitive problems but believed to be _____ _________ related

A

non anesthetic

67
Q

Skin _______ with age, and is prone to tearing. Veins are frail and hard to _________. Arthritic joints make _______ difficult

A

atrophies / cannulate / postioning

68
Q

Pharmacokinetic

A

relationship between drug dose and plasma concentrations

69
Q

Pharmacodynamic

A

relationship between plasma concentrations and clinical effect

70
Q

_________ in muscle mass and _______ in body fat

A

decrease / increase

71
Q

Total body water ________ which effects water soluble drugs

A

decreases

72
Q

Reduced volume for water soluble drugs can lead to higher _______ concentrations

A

plasma

73
Q

Conversely, fat soluble drugs with increased volume of distribution can lower _____ concentrations

A

plasma

74
Q

Many drugs have PROLONGED effects r/t ______ and ______ function declining

A

renal and hepatic

75
Q

MAC for inhalation agents decrease ___ % decade after age ____

A

4% / 40

76
Q

Onset of inhalation agents is more rapid if CO is ______

A

decreased

77
Q

Myocardial depressants effect exaggerated while the TACHY response is _______

A

decreased

78
Q

Reasons for longer wake up?

A

increased body fat, decreased hepatic and decreased pulmonary gas exchange

79
Q

Lower doeses needed for what drugs?

A

benzos, barbs, opiod agonists

80
Q

There is no change in muscle relaxant effectgs but there can be a ________ excretion due to decreased ________ function

A

prolonged / renal

81
Q

**Which plasma protein is increased in the elderly. It also binds with local anesthetics and opiods.

A

alpha-1 glycoprotein

82
Q

Progeria

A

Called Hutchinson-Gilford syndrome (premature aging)

83
Q

Progeria is apparent after ____ months of age

A

6 months

84
Q

Progeria patients will have signs of what?

A

heart disease, HTN, cerebrovascular disease, osteoarthritis, DM

85
Q

Airway considerations with Progeria

A

mandibular hypoplasia (underdevelopment), Micrognathis (micromandible), Narrow glottic opening

86
Q

Average life span for someone with progeria?

A

13 years

87
Q

Choose drugs wisely. Elderly patients have variable if not decreased requirements. Think REGIONAL, but always be prepared to administer ________ if unable to perform regional or if regional fails

A

general

88
Q

JUST FYI

A

give beta-blockers, ABX, AVOID hypothermia

89
Q

Be prepared for greater hemodynamic ________ inta-op and postop

A

instability

90
Q

Plan post op analgesia ________

A

carefully

91
Q

Monitor for sub-clinical events. Signs and symptoms of untoward events are often ______ in the elderly

A

nonspecific

92
Q

Allow the elderly more time to repsonse to questions, requests, drugs, and time to ______ from anesthesia/achieve extubation criteria

A

emerge

APA 2 (7 decks)

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