Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anes Final > Geriatric Anesthesia > Flashcards

Geriatric Anesthesia Flashcards

1
Q

beginning of the geriatric period

A

65 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

aging organ system changes

A
  1. Decreased functional Reserves

2. Increased susceptibility to stress induced & disease-induced organ system decomposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

changes in CVS of geriatric pt

SBP

A

increase SBP

SBP due to decreased elasticity of the media secondary
to fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

changes in CVS of geriatric pt

DBP

A

unchanged or decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

changes in CVS of geriatric pt

CO

A

Cardiac out declines (maintained in well-conditioned

healthy individuals)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

changes in CVS of geriatric pt

myocardial

A

Myocardial fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

changes in CVS of geriatric pt

valves

A

Calcification of the valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

changes in CVS of geriatric pt

baroreceptor reflexes

A

Depressed baroreceptor reflexes

baroreceptor less sensitive; normal decrease in BP > leads to increase HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

changes in CVS of geriatric pt

HR

A

Decline in HR (resting and maximal)

Due to: increase vagal tone (parasympathetic) &
decrease sensitivity of adrenergic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

changes in CVS of geriatric pt

rhytm

A

Increased incidence of arrhythmia

. due to Fibrosis of the conduction system
. Loss of SA node cells (pace maker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

changes in CVS of geriatric pt

diastoly

A

Diastolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

general mechanism of changes in CVS in geriatric pt

A

Reduction in arterial elasticity (due to fibrosis of the tunica media) > reduced arterial compliance > Increased afterload, elevated SBP and LVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

in geriatric pt, maximal HR declines by

A

approximately 1 beat

per minute per year of age over 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how is Diastolic dysfunction detected?

A

with Doppler echocardiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

in geriatric pt diastolic dysfunction is seen in

A

. Systemic HPN
. Coronary Artery Disease (esp. AS – aortic stenosis)
. Cardiomyopathies
. Valvular Heart Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is a result of Diastolic dysfunction

A

Results in large increase in end-diastolic pressure

& small changes of LV volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diastolic dysfunction is especially seen in

A

aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

perioperative consideration in geriatric pt (4)

A

. atrial enlargement
. diminished cardiac reserve
. prolong circulation time
. less ability to respond to hypovolemia, hypotension and hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

important of atrial enlargement in geriatric patient

A

. predisposes patients to SVT

. increased risk of CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

why is there Increased risk of CHF in geriatric pt

A

with older age, decreased compensation

to IVF > leads to CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how is Diminished cardiac reserve manifested in geriatric pt

A

Manifested as exaggerated drops in BP during GA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the importance of Prolonged circulation time in geriatric pt

A

. Delayed onset of IV drugs

. Speeds induction of Inhalational anesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

why is there Less ability to respond to hypovolemia, hypotension and hypoxia in geriatric pt

A

hypoxia: there is decrease reflex to CO2 receptor
due to increase pCO2 (accumulation) > leads to acidosis

normal pCO2 = 35 – 45 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is normal pCO2

A

normal pCO2 = 35 – 45 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

change in pulmonary function in geriatric pt

TLC

A

decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

change in pulmonary function in geriatric pt

VC

A

vital capacity decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

change in pulmonary function in geriatric pt

FEV1

A

minute volume decrease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

change in pulmonary function in geriatric pt

RV

A

residual volume increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

change in pulmonary function in geriatric pt

FRC

A

functional residual capacity increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

change in pulmonary function in geriatric pt

dead space

A

dead space increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

change in pulmonary function in geriatric pt

closing capacity

A

increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

change in pulmonary function in geriatric pt

what decreases?

A

TLC, VC, FEV1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

why are geriatric patients Prone to Bronchiectasis

A

Decreased pulmonary elasticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

in geriatric patients Decreased pulmonary elasticity results in

A

. Overdistention of alveoli- but with reduced alveolar surface area >
decrease efficiency of gas exchange

. Collapse of small airways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

collapse of small airways in geriatric pts results in

A

. increased RV
. increased closing capacity- exceeds
FRC at age 45 in supine & age 65 in sitting position > VP mismatch
. Emphysematous-like changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

rate of Decrease in arterial oxygen tension

A

average rate of 0.35mmHg per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

perioperative considerations in geriatric pt (5)

A 
. Increased chest wall rigidity
. Decreased muscle strength
. Homeostatic reflex mechanism of hypoxia & hypercapnia
are blunted
. Increased risk of aspiration
. Perioperative HYPOXIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Increased chest wall rigidity in geriatric pt is due to

A

Chostochondral calcification > rigid thorax

> increased work of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Decreased muscle strength in geriatric pt results in

A

. Decreased cough

. Decreased maximal breathing capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

risk of aspiration in geriatric pt

A

. pneumonitis
. Aspiration pneumonia common &life threatening > death
. Progressive decrease in protective laryngeal
reflexes
. Increased threshold stimulus needed for vocal cord closure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

mechanism of Perioperative HYPOXIA in geriatric pt

A

. Acute post-operative ventilatory impairment or failure > compromised ability of respiratory
muscles to respond to large increase in
ventilator requirement
. Decreased arterial oxygenation  diffuse V/P mismatch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

why is Post-operative pain control techniquesf important in elderly

A

increased threshold to pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

how to prevent Perioperative HYPOXIA in elderly

A

. Higher inspired oxygen concentrations
. Small increments of positive endexpiratory
pressure (PEEP)
. Aggressive pulmonary toilet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

changes in elderly and effects

skeletal muscle mass

A

. Progressive & generalized loss approximately 10%

. Decrease in maximal & basal consumption
. Slightly lowered cardiac output
. Diminished production of body heat, increased
heat loss

45
Q

changes in elderly and effects

Hypothalamic temperature

A

. regulating center
rest at lower level > intraoperative hypothermia
. 1◦C per hour decrease (core body temp)
. Prolonged time for post-op re-warmin

46
Q

changes in elderly and effects

body fat

A

. Increased in the proportion of body fat

47
Q

changes in elderly and effects

insulin resistance

A

. Increasing insulin resistance > progressive decrease in the ability to handle glucose loads

48
Q

how does increase lipid fraction in elderly delay recovery

A

. Larger proportion of total body mass than can
serve as reservoir for lipidsoluble drugs > Increased volume of distribution > extended elimination time > delay
recovery

49
Q

changes in elderly and effects

intracellular water

A

Reduction in intracellular water > contracted IC volume

50
Q

changes in elderly and effects

plasma volume, red cell mass, ECF volume

A

Preserved plasma volume, red cell mass, ECF volume

51
Q

NEUROENDOCRINE RESPONSE TO STRESS in elderly

A

. Preserved or slightly decreased
. Decreased response to beta-adrenergic agents (Physiological Beta-blockade)
. Circulating norepinephrine levels elevated

52
Q

Renal tissue mass

By age 70
By age 80

A

. By age 70 → reduced by 30%

. By age 80 → # of functioning glomeruli ½ of young adult

53
Q

Renal blood flow changes in elderly

A

. Reduced by 50%
. GFR declines by 1% to 1.5% per year
. Creatinine clearance decreases 1% per year after age 40
. Renal cortex (increase in renal fats, interstitial fibrosis) more affected than renal medulla

54
Q

Serum creatinine changes in elderly

A

. Remain within normal limits- decline skeletal muscle mass &
creatinine production > lower creatinine load

55
Q

Blood Urea Nitrogen changes in elderly

A

Gradually increases (0.2 mg/dL per year)

56
Q

ADH and Aldosterone changes in elderly

A

Less responsive to ADH and Aldosterone

57
Q

why is the elderly Predisposed to dehydration or fluid overload

A

Impaired sodium handling, concentrating ability & diluting capacity

58
Q

perioperative consequences of renal change in elderly

A

. Decrease ability to excrete drugs
. Decrease capacity to handle water & electrolytes → difficult fluid management
. Predispose to develop hypo/hyperkalemia
. Diminished thirst, poor diet, use diuretics

59
Q

HEPATOCELLULAR FUNCTION changes in elderly

Microsomal & non-microsomal hepatic enzyme

EXCEPTION

A

Microsomal & non-microsomal hepatic enzyme activity not
altered

EXCEPT for benzodiazepines & cimetidine

60
Q

HEPATOCELLULAR FUNCTION changes in elderly

liver tissue mass

A

Decreased liver tissue mass (40% by age 80) – normal

61
Q

HEPATOCELLULAR FUNCTION changes in elderly

hepatic blood flow

A

. Decreased hepatic blood flow

Slows metabolism > elevated blood levels > delay elimination of drugs in the body

62
Q

HEPATOCELLULAR FUNCTION changes in elderly

Hepatic biotransformation & protein synthesis

A

. altered by stress,
disease & surgery

. Arterial hypotension, lox cardiac output, hypothermia

63
Q

HEPATOCELLULAR FUNCTION changes in elderly

Plasma cholinesterase levels

A

reduced

64
Q

HEPATOCELLULAR FUNCTION changes in elderly

Gastric pH

A

Gastric pH increase

65
Q

HEPATOCELLULAR FUNCTION changes in elderly

Gastric emptying time

A

Gastric emptying time prolonged – bec. of decreased peristaltic activity

66
Q

HEPATOCELLULAR FUNCTION changes in elderly

gastric volumes

A

Lower gastric volumes

67
Q

two physiological changes in elderly delays elimination of drugs in elderly

A

. Decreased hepatic blood flow> Slows metabolism > elevated blood levels > delay
elimination of drugs in the body

. Larger proportion of total body mass than can
serve as reservoir for lipid soluble drugs > Increased volume of
distribution > extended elimination time > delay
recovery

68
Q

CNS changes in elderly

Brain size

A

. Brain size decreases (20%) – atrophy if less used
. Neuronal loss more prominent in the cerebral cortex (esp frontal lobe)
. Neurons decreases in size & complexity of their dendritic tree &
synapses

69
Q

CNS changes in elderly

Synthesis of neurotransmitters

A

Synthesis of neurotransmitters reduced (low pressure hydrocephalus)

70
Q

CNS changes in elderly

Astrocytes & microglial cells

A

increase

71
Q

CNS changes in elderly

Cerebral flow reduced in proportion to brain tissue

A

Cerebral flow reduced in proportion to brain tissue decrease (20-30%) – VERY IMPORTANT

72
Q

CNS changes in elderly

Cerebral autoregulation of blood flow

A

Cerebral autoregulation of blood flow is preserved

73
Q

CNS changes in elderly

Cerebral vasoconstrictor response to hyperventilation

A

remains intact →

less bleeding

74
Q

CNS changes in elderly

Cognitive function

A

Cognitive function normally modest but variable

75
Q

CNS changes in elderly

Comprehension & long-term memory

A

Comprehension & long-term memory intact

76
Q

CNS changes in elderly

Short-term memory, visual & auditory reaction times

A

Short-term memory, visual & auditory reaction times reduced

77
Q

PNS changes in elderly

peripheral nerve cells

A

. Degeneration of peripheral nerve cells > results in prolonged
conduction velocity & skeletal muscle atrophy
. Gradual but significant deterioration of electrical conduction along efferent motor pathways

78
Q

PNS changes in elderly

sensory modal

A

. Increasing threshold for nearly all sensory modalities > touch,
temperature sensation, proprioception, hearing and vision.
. Increased threshold intensities of stimuli needed to initiate all
forms of perception

79
Q

PNS changes in elderly

motor neuron end-plates

A

. Decrease motor neuron end-plates→ offset of the increase total number
of cholinesterase
. Dose requirement for neuromuscular blockers not decreased

80
Q

ANS changes in elderly

Neurons in sympathoadrenal pathways

A

Neurons in sympathoadrenal pathways undergo cellular attrition > decrease adrenal & cortisol secretion

81
Q

ANS changes in elderly

autonomic end organ responsiveness

A

. Marked reduction in autonomic end organ responsiveness due to
decrease number of receptors of change in receptor morphology;
. Reduced response o beta agonists

82
Q

Dose requirement for neuromuscular blockers (not decreased/decreased) in elderly

A

Dose requirement for neuromuscular blockers NOT decreased

Decrease motor neuron end-plates→ offset of the increase total number of cholinesterase

83
Q

changes of MUSCULOSKELETAL SYSTEM in elderly (5)

A

. Muscle mass reduced
. Extrajunctional spread of acetylcholine receptors
. Skin atrophy > prone to trauma from adhesion tapes, electrocautery
pads. EKG electrodes
. Veins > frail & easily ruptured by IV infusion
. Arthritic joints > interfere with poisoning

84
Q

Principal pharmacologic change in elderly

A

reduced anesthetic requirement

85
Q

pharmacologic change in elderly

A

. Reduced volume of distribution > Water-soluble drugs → higher plasma concentration
. Elimination half-life > prolonged if Vd is increased
. Distribution & Elimination
. Affected by altered plasma protein binding:
. Anesthetic requirements reduced with increasing age
. Onset of action → Rapid if cardiac output is depressed
. Delayed if (+) V/P mismatch

86
Q

pharmacologic change in elderly

Minimum Alveolar Concentration (MAC)

A

reduced by 4% per decade of age over 40 years

87
Q

Anesthetic requirements reduced with increasing age (3) mechanism

A

. Increase sensitivity due to fundamental neurophysiologic than
pharmacologic process
. Decreased requirements parallels reduced brain
neurotransmitter activity
. Progressive, age related decline in nervous system functional
reserve

88
Q

albumin (decrease/increase) with age and binds to

A

. Albumin decreases with age > binds to acidic drugs (barbituates, benzodiazepines & opiates)

89
Q

A1-Acidic glycoprotein (decreases/increases) and binds to

A

A1-Acidic glycoprotein increases → binds with basic drugs (LA)

90
Q

what are volatile anesthetics in elderly

A

Isoflurane & Desflurane

91
Q

effect of Isoflurane & Desflurane on elderly

A

. Tachycardic effects attenuated in elderly patients

. Reduces cardiac output & heart rate

92
Q

effect of volatile anesthetics in elderly

A

. Myocardial depressant effect of volatile anesthetics

. Exaggerated in elderly patients

93
Q

why is Recovery from volatile anesthetics prolonged in elderly

A

. Increased Vd (2◦ to ↑ body fat)
. Decreased hepatic function (depressed
halothane metabolism)
. Decreased pulmonary gas exchange

94
Q

NONVOLATILE ANESTHETICS used in elderly

A

barbituates, opiates,

benzodiazepines

95
Q 
in elderly (lower/higher) dose requirement for barbituates, opiates,
benzodiazepines
A

LOWER dose requirement for barbituates, opiates,

benzodiazepines

96
Q

why is there increases brain sensitivity to narcotics in elderly

A

Delayed inter-compartmental transfer of drugs (pharmacokinetic mechanism)

97
Q

why is there a lower dose for barbituates in elderly

A 
Slower distribution from central compartment to
equilibrating compartments (pharmacokinetic
mechanism)
98
Q

why is there a lower dose for opioid agonists in elderly

A

. Pharmacokinetics > smaller initial Vd, prolonged elimination half-life
. increased brain sensitivity

99
Q

why is there a lower dose for bezodiazepines in elderly

A

Diazepam accumulate in fats > Vd larger in elderlies, elimination slowed (t ½ = 36hrs)

100
Q

Larazepam (less/more) lipid soluble than diazepam

A

Larazepam LESS lipid soluble than diazepam

101
Q

regional anesthesia used in elderly

A

spinal, epidural, muscle relaxants

102
Q

spinal anesthesia in elderly

A

. Decreased blood flow to SAS > slower absorption
. Smaller volume of CSF with higher specific gravity > higher final concentration
. Accentuated degrees of lumbar lordosis & thoracic kyphosis > increases cephalad spread & pooling in the
thoracic segments

103
Q

EPIDURAL ANESTHESIA in elderly

A

. difficult to position the patient
. Narrowing of the intervertebral spaces → requires smaller local
anesthetic dose → Decreased segmental dose required

104
Q

what is the only drug you will not adjust in elderly

A

MUSCLE RELAXANTS

105
Q

onset of muscle relaxants in elderly

A

Prolonged onset: due to decreased cardiac output & slow muscle
blood flow

106
Q

which drugs are excreted renally that is used in elderly

DOXACURIUM
METOCURINE
PANCURONIUM
RONCURONIUM
TUBOCURARINE
VECURONIUM
A

METOCURINE, PANCURONIUM,

DOXACURIUM, TUBOCURARINE

107
Q

which drugs are excreted hepatically that is used in elderly

DOXACURIUM
METOCURINE
PANCURONIUM
RONCURONIUM
TUBOCURARINE
VECURONIUM
A

RONCURONIUM, VECURONIUM

108
Q

elderly (men/women) have lower plasma cholinesterase levels resulting in >

A

Elderly men →lower plasma cholinesterase levels →prolonged

succinylcholine effect

109
Q

PROMPT and COMPLETE post-op recovery of mental function management in elderly

A

a. IV sedation after regional anesthesia may delay rapid recovery
b. Cold O.R. contributes to post-op
by direct depressant effects of low body temperature and
suppression of drug clearance
c. Physical management in the O.R. & postoperatively requires
special precautions
d. Post-op bleeding & bacterial infection are more likely to occur
e. Post-op pain management is important for promoting healing
and for reduced cardiovascular and pulmonary demands

Anes Final (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions