Geriatric Anesthesia - Quiz 8 Flashcards
What CV Decreases are seen in Geriatrics?
↓Artery Elasticity
↓HR @ Rest & Max
↓Baroreceptor Response
↓Adrenergic Activity
What CV Increases are seen in Geriatrics?
↑Afterload
↑SBP
LV Hypertrophy
What are common Geriatric CV Problems?
Aortic Stenosis
HTN
CAD
CHF
Arrythmias
How does HR change after the age of 50?
Decreases by 1 bpm per year after 50
Why are the chances of arrythmias higher in the elderly?
Fibrosis of Conduction System & Loss of SA Node Cells
What is the concern regarding Atrial Enlargement in Geriatrics?
More risk of SVT & A-Fib
What is Eccentric Hypertrophy?
Ventricular dilation w/ normal Sarcomere Lengths - wall thickness proportional to chamber radius
What is Concentric Hypertrophy?
Wall thickness greatly increases, while chamber radius stays the same d/t newly added Sarcomeres from Chronic Pressure Overload
Why is there such a profound drop in BP during induction with Geriatrics?
Autonomic Dysfunction
How does Slow Circulation in Geriatrics affect Induction?
Slows IV Drugs, but Speeds Gas Induction
What CV Reponses are Blunted in regards to Beta Receptors?
↓Max HR
&
↓Peak EF
How does the elderly patient increase their Cardiac Output?
Elderly Cardiac Output is more dependent on End-Diastolic Volume rather than Heart Rate
Why is the Geriatric patient more prone to CHF when receiving large volume of fluids?
Anesthetic-induced Myocardial Depression & Hypotension + they can’t really increase their HR much.
What Decreases are seen in the Geriatric Respiratory System?
↓Lung Elasticity
↓Alveolar Surface Area
↓Cough
↓Response to Hypercapnea & Hypoxia
↓Max Breathing Capacity
What Increases are seen in the Geriatric Respiratory System?
↑Residual Volume
↑Chest Wall Rigidity
↑Closing Capacity & Volume
↑Alveoli Over Distention
↑Collapsed Small Airways
↑Dead Space
↑FRC
V/Q Mismatch
What are common Geriatric Respiratory problems?
Lung CA
Pneumonia
Emphysema
Chronic Bronchitis
How is Mask Ventilating & Intubating affected by Geriatrics?
Mouth Opening & Cervical Spine Arthritis
No teeth = Difficult Masking, but better view
Why are the elderly more at risk for aspiration?
Decreased Airway Reflexes
What is the Post-Op concern for Geriatrics?
Shallow Breathers - use narcotics judiciously, may require re-intubation
How does age affect Vital Capacity?
Significantly decreases by 25 mL per year after 20 years old
What are the GI changes in Geriatrics?
↑Gastric pH
↓Gastric Emptying
↓Stomach Volume
Elderly patients have ______ Heat Production & _____ Heat Loss d/t a decreased Metabolic Rate & Thermoregulation
Elderly patients have LESS Heat Production & MORE Heat Loss d/t a decreased Metabolic Rate & Thermoregulation
What are the Renal Changes in Geriatrics?
Decreased GFR, Renal Blood Flow, Renal Mass, and all normal Functions
What are common Renal Problems in Geriatrics?
Prostatic Obstruction
Hypertensive Nephropathy
Diabetic Nephropathy
What causes a decline in Renal Function in Elderly Patients?
Renal Cortex replaced w/ Fat & Fibrotic Tissue
How much does BUN increase per year?
0.2% mg/dL per year
What is the most specific test of Renal Failure?
24 hr Serum Creatinine Clearance
Which part of the Nervous System decreases in Geriatrics?
↓CBF & Brain Mass
↓Neurotransmitters & Receptors
How does physical activity affect Cognitive Function?
More Physical Activity = Preservation of Cognitive Function
What causes Muscle Atrophy in the Elderly?
Degeneration of Peripheral Nerves that slows Conduction & Reaction
What Nervous System thresholds increase in the Geriatric Patient?
Touch
Temp
Pain
Propioception
Hearing & Vision
Geriatric patients require ______ Local & General Anesthetics
Geriatric patients require LESS Local & General Anesthetics
Epidural Anesthetics tend to spread which way for Geriatric Patients?
More Cephalad
For Geriatrics, Analgesia & Motor anesthetics have a ______ duration and need ____ time to recover Cognitively from General Anesthetics
For Geriatrics, Analgesia & Motor anesthetics have a SHORTER duration and need MORE time to recover Cognitively from General Anesthetics
How do Anticholinergics like Scopolamine & Atropine affect the Elderly?
Hypersensitive to Anticholinergics
The relationship b/t Drug Dosage & Plasma concentration is known as what?
Pharmacokinetics
What is Pharmacodynamics?
Relationship b/t Plasma Concentrations & Clinical Effect
How does the Decreased Total Body Water in Geriatrics affects drugs given?
Affects Water-Soluble Drugs & can lead to Higher Plasma Concentrations
How does the increase in Body Fat in the Elderly affect Lipid Soluble Drugs?
More Volume Distribution, which can lower Plasma Concentrations
How much does MAC decrease per decade after 40?
4% per Decade after 40
Why would Geriatric Patients take longer to wake up even though they maintained normothermia?
Increased Body Fat
Decreased Hepatic Function
Decreased Pulm. Gas Exchange
Older patients need less Opioids, Benzos, and Barbs, but how do Muscle Relaxors affect them?
No change in NMB effect, but prolonged renal excretion
How does protein binding change in Geriatrics?
Older patients have more Alpha-1 Glycoprotein, which binds to Local Anesthetics & Opioids
What is Hutchinson-Gilford Progeria?
Premature aging that becomes apparent after 6 months of age w/ an average lifespan of 13 years
What comobidities are often associated w/ Progeria?
Ischemic Heart Disease
HTN
Cerebrovascular Disease
OA
DM
What might make intubating a Progeria patient difficult?
Mandibular Hypoplasia
Micrognathia
Narrow Glottic Opening
What are the general anesthetic considerations when working w/ Geriatrics?
Consider Regional > GA
Give B-Blockers
Give Abx
Avoid Hypothermia
