Geriatrics 2 Flashcards
Which factor remains unchanged in the healthy geriatric patient?
a. pulse pressure
b. systolic function of the heart
c. systemic vascular resistance
d. lusitropy
b. systolic function of the heart
What happens to BP as we age?
increases
What happens to pulse pressure as we age?
increased
What happens to diastolic function as we age?
decreased
What happens to systolic function as we age?
no change
What happens to stroke volume as we age?
decreased
What happens to cardiac output as we age?
decreased
What happens to heart rate as we age?
decreased
Arterial stiffness increases__________ to a greater degree than __________
SBP; DBP
A decreased cardiac output leads to a
prolonged circulation time
Which factor decreases as a result of the aging process?
a. baroreceptor sensitivity
b. incidence of orthostatic hypotension
c. plasma norepinephrine concentration
d. sympathetic tone
a. baroreceptor sensitivity
What happens to SNS tone as we age?
increased
What happens to PNS tone as we age?
decreased
What happens to baroreceptor function as we age?
decreased
What happens to ability to thermoregulate as we age?
decreased
What happens to responsiveness to catecholamines as we age?
decreased
________ dysfunction is associated with the normal aging process
Autonomic
There is _____________ concentration in the plasma as we age
higher norepinephrine
The decreased PNS tone may lead to
encumberment of the ability of anticholinergics to increase heart rate
Reduced baroreceptor response increases the risk of
orthostatic hypotension
syncope
greater degree of hemodynamic compromise following sympathectomy
By what percentage does MAC decrease for each decade of life after 40 years of age?
6% per decade
What happens to brain mass as we age?
decreased
What happens to neurotransmitter activity in the brain as we age?
decreased
What happens to the peripheral nerve quantity and function as we age?
decreased
The most common perioperative CNS complication in the elderly is
postoperative delirium
Postoperative delirium tends to occur _______________, while postoperative cognitive dysfunction tends to occur _________
early in the postoperative period; weeks to months after surgery
Treatment for postoperative delirium includes
reversing the underlying cause
antipsychotics
minimizing polypharmacy
What is the treatment for postoperative cognitive dysfunction?
there’s no specific treatment
Most cases of POCD resolve
after about 3 months and are mild
Risk factors for postoperative delirum include
drugs
electrolyte imbalance
lack of drugs (withdrawal)
infection (UTI and respiratory)
reduced sensory input
intracranial dysfunction
urinary retention and fecal impaction
myocardial event, male gender
(spells delirium)
What is the presentation of postoperative delirium?
disordered behavior
perception
memory
psychomotor skills
What is the presentation of postoperative cognitive dysfunction?
subtle and difficult to pinpoint
impaired concentration, comprehension, and psychomotor skills
Risk factors for postoperative cognitive dysfunction include
advanced age (most significant risk factor)
pre-existing cognitive deficit
cardiac surgery
long duration of surgery
high ASA status
low level of education
anesthetic agents
_________ matter atrophies at a faster rate than _________ matter
grey; white
The dose of IV induction agents for the elderly patient should be reduced by
30-40%
What is the sensitivity of the elderly persons brain to anesthetic agents?
increased
Alzheimer’s disease is characterized by
decreased acetylcholine
Parkinson’s disease is characterized by
decreased dopamine in the basal ganglia
Identify the statements that MOST accurately describe neuraxial anesthesia in the elderly patient. (select 2)
a. spinal anesthesia is associated with a lesser spread of local anesthetic
b. CSF volume is increased
C. epinephrine test dose has a higher rate of a false-negative result
d. epidural anesthesia is associated with a greater spread of local anesthetic
c. epinephrine test dose has a higher rate of a false-negative result
d. epidural anesthesia is associated with a greater spread of local anesthetic
Describe the elderly patients sensitivity to epidural anesthetics.
increased
Describe the elderly patients’ sensitivity of nerve tissue to local anesthetics.
increased
Describe the elderly patients’ sensitivity to intrathecal anesthetics
increased
Describe the difficulty of neuraxial block placement in the elderly patient.
increased
Describe the elderly patient’s response to epi test dosing.
decreased
What is the CSF volume of the elderly patient?
decreased resulting in greater spread of LA
