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24 Principles of Anesthesia II > Geriatrics (Exam II) > Flashcards

Geriatrics (Exam II) Flashcards

1
Q

Memory decline is related to inability to complete _____.

A

ADL’s

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2
Q

Changes in the nervous system associated with aging include what three things?

A
  • Cerebral Atrophy
  • ↓ Gray matter
  • ↓ White matter
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3
Q

Brain ventricle size will ______ with age.

A

increase

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4
Q

Which of the following neurotransmitters show a decrease associated with aging?

Dopamine
ACh
NE
Serotonin
Glutamate

A

Dopamine
ACh
NE
Serotonin

Glutamate is unchanged.

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5
Q

Coupling of CMRO₂, CBF, and EEG is increased or decreased due to aging?

A

Trick question. CMRO₂, CBF, and EEG remain unchanged secondary to aging.

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6
Q

Is epidural space increased or decreased due to aging?

A

Decreased

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7
Q

What occurs with dura permeability secondary to aging?

A

Dura permeability increases.

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8
Q

What occurs with CSF volume secondary to aging?

A

Volume of CSF decreases.

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9
Q

What two changes are seen in myelinated fibers of dorsal and ventral nerve roots secondary to aging?

A

↓ diameter of roots
↓ number of roots

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10
Q

Elderly patients are more/less sensitive to neuraxial and peripheral nerve blocks?

A

more sensitive

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11
Q

Decreases in what two characteristics of the peripheral nervous system are noted secondary to aging?

A
  • Inter-Schwann cell distance
  • Conduction velocity
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12
Q

What cardiac changes are noted due to aging?

A
  • ↓ myocyte number
  • ↓ SA node cells
  • ↓ conduction velocity
  • ↓ contractility
  • ↓ β-adrenergic sensitivity
  • Thickened LV & aortic valve
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13
Q

What happens to vasculature as we age? Why?

A

Vessels become more stiff

  • ↓ collagen & elastin
  • ↓ Nitric Oxide vasodilation
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14
Q

What two factors are decreased in the lungs as we age?

A
  • ↓ Elastic recoil
  • ↓ Surfactant
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15
Q

What anatomic structures of the lungs become enlarged as we age? What is the result?

A

Bronchioles and alveolar ducts become enlarged leading to early collapse of small airways.

↑ VD
↑ closing capacity
impaired gas exchange

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16
Q

Loss of vertebral height and calcification of vertebrae lead to what three respiratory system consequences?

A
  • Barrel chest
  • Diaphragmatic flattening
  • Chest wall stiffening
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17
Q

Will the following see an increase or a decrease due to aging-related lung changes?

  • Vital Capacity
  • Closing Capacity
  • Residual Volume
A
  • ↓ VC
  • ↑ CC
  • ↑ RV
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18
Q

FEV₁ will decrease by ___% per decade.

A

6-8%

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19
Q

What are the results of weaker pharyngeal muscles from aging-related changes?

A
  • ↓ secretion clearance
  • ↓ esophageal motility
  • ↓ protective upper airway reflexes
  • Inefficient coughing
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20
Q

Whats the most important mechanism of action for aging-related A-a gradient changes?

A

FRC & CC mismatch increasing

Increasing shunt w/ decreasing arterial oxygenation.

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21
Q

What renal consequences are there to aging?

A
  • ↓ GFR
  • ↑ Urinary retention
  • ↑ UTI’s
  • Blunted response to aldosterone, vasopressin & renin
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22
Q

Which phase of liver metabolism is more affected by aging?

A

Phase I more impaired

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23
Q

What are the components of Phase I liver metabolism?

A
  • Oxidation-Reduction
  • CYP450 Hydrolysis
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24
Q

What is the mechanism for increased PONV in the elderly?

A

Trick question. Less PONV in the elderly.

Avoid Prochlorperazine, promethazine, & metoclopramide.

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25
Q

With aging, muscle mass will ______ while subcutaneous fat will _______.

A

decrease; also decrease

26
Q

What are some significant predictors of 6month & 1 year mortality for the elderly?

A
  • Impaired cognition
  • Recent fall
  • ↓ Albumin
  • Anemia
  • Functional dependence
  • Comorbidities
27
Q

What four factors are thought to be involved in the pathogenesis of dementia?

A
  • Amyloid plaques
  • Tau
  • Ca⁺⁺
  • Neuroinflammation
28
Q

Where do amyloid plaques accumulate intracellularly?

A

Trick question. Amyloid accumulates extracellulary.

29
Q

What are amyloid plaques thought to do in the CNS?

A

Disrupt cell membranes

Function actually unknown, synaptic origin.

30
Q

What results were seen (regarding amyloid β) with mice who were administered volatile anesthetic?

A
  • Young mice had improved memory/learning
  • Old mice had accelerated dementia

More study necessary.

31
Q

What medication class can cause a significant increase in amyloid plaques?

A

Volatiles Anesthetics

32
Q

What is a neurofibrillary tangle?

A

Phosphorylated and aggregated τ (tau) proteins

33
Q

What is destabilized by neurofibrillary tangles?

A

Microtubules

34
Q

Decreases in temperature by ___ °C will increase the amount of τ protein.

A

2-3 °C

35
Q

Repeated exposure to what drug class will cause an increase in phosphorylated τ protein?

A

VAA’s (specifically halothane, isoflurane, & sevo)

36
Q

Flip card to see graph of Amyloid and Tau relations to symptoms.

A
37
Q

Release of what ion is exaggerated due to anesthesia? What receptors are involved?

A

Release of Ca⁺⁺ from ryanodine and IP₃ receptors of endoplasmic reticulum.

38
Q

Exaggerated Ca⁺⁺ release in the brain is thought to be linked to ______________.

A

neurotoxicity

39
Q

Does dantrolene cross the blood brain barrier?

A

No

40
Q

Neuroinflammation contributes to cognitive decline through the release of which three inflammatory factors?

A
  • Cytokines
  • IL-6
  • TNFα
41
Q

What anesthetic drugs (mentioned in lecture) could be used to counteract inflammation?

Sus, because I checked and only one of these crosses the BBB.

A

Dexamethasone
Ketorolac
Lidocaine (actually can cross BBB)

42
Q

General anesthesia (especially in older populations) is thought to contribute to ______.

A

POCD (Post-op cognitive dysfunction)

43
Q

What studies support the theory of anesthesia related to post-operative cognitive dysfunction?

A
44
Q

Anesthesia is ______ for POCD, whilst surgery is likely ________.

A

Causative; additive

45
Q

What occurs to drugs due to decreased cardiac output secondary to aging?

A
  • Slower distribution to site of action
  • Slower redistribution
  • Slower distribution to metabolic organs
46
Q

What neuromuscular junction changes contribute to drug challenges in an aging patient?

A
  • ↑ distance between axon and motor end plate
  • ↓ concentration of ACh receptors
  • ↓ ACh in presynaptic vesicle
  • ↓ ACh release
47
Q

What drug changes are seen in an aging patient regarding kidney/liver dependent metabolism?

A
  • Prolonged drug effect
  • Decreased drug need during maintenance
  • Delayed recovery phase for non-depolarizing NMB’s
48
Q

What is the algorithm for preoperative assessment of Thoracic surgery patients?

A
49
Q

How is predicted post-operative FEV₁ (ppo FEV₁) calculated?

A

(Preop FEV₁ %) x (1 - % of lung tissue removed/100)

50
Q

How many lung segments are there?

A

42 total

51
Q

How many lung segments are in the LUL?

A

10

52
Q

How many lung segments are in the RLL?

A

12

53
Q

How many lung segments are in the RUL?

A

6

54
Q

How many lung segments are in the RML?

A

4

55
Q

The right middle lobe and right lower lobe are resected in a critically ill patient. How much lung tissue was removed in this surgery?

A

16/42 = 38%

56
Q

Predict the post-operative FEV₁ for a patient who had their right lower lobe removed. The patients preoperative FEV₁ is 70%.

A

(Preop FEV₁ %) x (1 - % of lung tissue removed/100)

PPO FEV₁ =70 x ( 1 - 28/100) = 50

57
Q

What is the “triad” of preoperative thoracotomy assessment?

A
58
Q

How would the CRNA manage extubation on a post-thoracotomy patient if the PPO FEV₁ is >40% ?

A

If > 40%, extubate in OR if awake, warm, & comfortable (AWaC)

59
Q

How would the CRNA manage extubation on a post-thoracotomy patient if the PPO FEV₁ is 30 - 40% ?

A

Consider extubation based on:

  • Exercise tolerance
  • DLCO
  • V/Q
  • Comorbidities
60
Q

How would the CRNA manage extubation on a post-thoracotomy patient if the PPO FEV₁ is <30% ?

A
  • Staged weaning from ventilator
  • Consider extubation if >20% plus thoracic epidural anesthesia in place.

24 Principles of Anesthesia II (23 decks)

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