Geriatric Anesthesia Flashcards
Physiologic Changes
Mechanisms of Aging
Hemodynamic Stability
- The change in sympathetic nervous system activity that accompanies a change in blood pressure is actually enhanced with age.
- Despite the likelihood that the alpha-receptor response to stimulation may decrease slightly with age, the vasoactive component of the baroreflex in the elderly is as effective as in young adults, if not more so.
Cardiovascular System
Heart Rate and Cardiac Reserve
Oxygen Carrying Capacity
Exercise Tolerance
Contractility
Systolic Hypertension
This figures illustrates the composition of the arterial pressure waveform from a combination of a forward pressure wave created by ventricular contraction and a reflected wave.
Venous Stiffening
Autonomic Function
Decreased Response to Atropine
Ventilatory System
Central Nervous System
Body Composition
Renal Function
Hepatic Function
Basal Metabolic Rate
Airway Reflexes
Airway Management
Anesthetic Requirements
Regional vs. General
Regional
SAB/ Epidural
Labile BP with SAB/Epidural
Question
Choice of Agents
Propofol
Opioids
Ketamine
Perioperative Risk and Outcome
Management of Hypotension
- Fine line between too much and too little volume
- Try to resuscitate volume prior to surgery, clear liquids permitted up to 2 hours before surgery
- Usual volume replacement can lead to excessive fluid once anesthetic is done, sympathetic activity decreases. “Run the patient dry”
- Use endpoints such as urine output, decreased central venous pressure, or pulmonary wedge pressure, echo, etc.
- Age is rarely indication for central venous or pulmonary artery, indicated by procedure
- If low SVR, a-agonist (phenylephrine) is best choice, plus volume administration is best
- Low dose dopamine or epinephrine may work better
Dementia and General Anesthesia
Dementia and General Anesthesia
Post-operative Cognitive Decline
What’s the cause of dementia?
Marcantonio (2001)
Ofirmev
Conclusion
