Pharmacology & Anesthesia Flashcards
List the top six surgeries in the geriatric population, from most to least frequent.
The top five geriatric surgeries, in order of frequency are: (1) orthopedic (2) ophthalmologic (3) gastrointestinal (4) urological (5) vascular, and (6) gynecologic. [Kirby, Gravenstein, Lobato and Gravenstein, Clin. Aries. Pract, 2002, p1128]
⚡️Which organ system (non-surgical) is of greatest perioperative and postoperative concern in the geriatric patient?
⚡️Cardiovascular disease is the most common concomitant illness in the older adult is thus the primary cause for perioperative and postoperative risk and concern in the geriatric/elderly patient. [Nagelhout, N A , Sc. 2013 p1217]
Will muscle relaxants that are eliminated by renal or hepatic mechanisms have a shortened or prolonged elimination half‐life in the geriatric patient?
Prolonged, because of reduced renal and hepatic function. [Nagelhout, N A , 5e. 2013 p1218‐1219]
Is the volume of distribution of water‐soluble drugs (muscle relaxants) increased or decreased in the elderly? Lipid-soluble drugs (IV anesthetics)? Explain your answer.
The volume of distribution is decreased for water‐soluble (hydrophilic) drugs and increased for lipid‐soluble (liphophilic) drugs. These changes are due to increased fat stores, decreased lean body mass and decreased total body water. [Nagelhout, N A , 5e. 2013 p1221]
Why is the elimination of midazolam (Versed) prolonged in the elderly?
Decreases in hepatic bloodflow and possibly decreases in hepatic metabolism (decreased clearance) may cause as much as a doubling of the elimination half-time in the elderly (Stoelting). Recall that half‐time of elimination increases if clearance decreases and/or volume of distribution increases. [Stoelting,PPAP,3e. 1999p128]
Is an intravenous induction faster or slower in the geriatric patient compared with the young adult? Is an inhalational induction faster or slower compared with the young adult?
Because circulation time is prolonged in the elderly patient, an intravenous induction is slower and an inhalational induction is faster. [Nagel‐ hout, N A , 5e. 2013 p1215]
The elimination half-life of IV anesthetics is generally increased in elderly patients for what three reasons?
(1) Decreased hepatic metabolism develops either because of decreased hepatic enzyme levels or reduced hepatic circulation, (2) plasma protein binding of drugs in the elderly is often decreased, giving rise to a larger volume of distribution and alonger half-life, and (3) there is an increase in the percentage of fat which increases the volume of distribution and prolongs the half-life of lipid‐soluble drugs. [Nagelhout, N A , 5e. 2013 p1221]
⚡️Neurologic issues are the most common postoperative complication in the older patient. Identify the three (3) most frequent neurologic complications in the older patient.
⚡️The most common type of complication is older adults is neurologic. The most frequent neurological complication in older adults is postoperative delirium (15% to 53%), followed by stroke and peripheral nerve damage. [Nagelhout, N A , Sc. 2013 p1220]
What is the incidence of post operative delirium in the elderly? After what type of surgery is postoperative delirium most common in the elderly?
The incidence of postoperative delirium in the elderly is 10‐53% and occurs more common after orthopedic (35% after emergent hip surgery) and cardiac procedures. [Nagelhout, N A , 5e. 2013 p1220; Barash, Clin. Anes, 76. 2013 p902]
