Geriatric Anesthesia - Quiz 8 Flashcards by Donny Le

What CV Decreases are seen in Geriatrics?

↓Artery Elasticity

↓HR @ Rest & Max

↓Baroreceptor Response

↓Adrenergic Activity

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What CV Increases are seen in Geriatrics?

↑Afterload

↑SBP

LV Hypertrophy

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What are common Geriatric CV Problems?

Aortic Stenosis

HTN

CAD

CHF

Arrythmias

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How does HR change after the age of 50?

Decreases by 1 bpm per year after 50

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Why are the chances of arrythmias higher in the elderly?

Fibrosis of Conduction System & Loss of SA Node Cells

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What is the concern regarding Atrial Enlargement in Geriatrics?

More risk of SVT & A-Fib

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What is Eccentric Hypertrophy?

Ventricular dilation w/ normal Sarcomere Lengths - wall thickness proportional to chamber radius

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What is Concentric Hypertrophy?

Wall thickness greatly increases, while chamber radius stays the same d/t newly added Sarcomeres from Chronic Pressure Overload

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Why is there such a profound drop in BP during induction with Geriatrics?

Autonomic Dysfunction

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How does Slow Circulation in Geriatrics affect Induction?

Slows IV Drugs, but Speeds Gas Induction

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What CV Reponses are Blunted in regards to Beta Receptors?

↓Max HR

↓Peak EF

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How does the elderly patient increase their Cardiac Output?

Elderly Cardiac Output is more dependent on End-Diastolic Volume rather than Heart Rate

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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.

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What Decreases are seen in the Geriatric Respiratory System?

↓Lung Elasticity

↓Alveolar Surface Area

↓Cough

↓Response to Hypercapnea & Hypoxia

↓Max Breathing Capacity

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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

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What are common Geriatric Respiratory problems?

Lung CA

Pneumonia

Emphysema

Chronic Bronchitis

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How is Mask Ventilating & Intubating affected by Geriatrics?

Mouth Opening & Cervical Spine Arthritis

No teeth = Difficult Masking, but better view

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Why are the elderly more at risk for aspiration?

Decreased Airway Reflexes

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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