Systemic Changes Flashcards
1
Q
Systolic hypertension
A
Progressive, gender independent
2
Q
Systolic HTN is Due to
A
fibrosis of elastic tissues which Raises ventricular wall
tensions, workload
3
Q
Workload increase Causes
A
hypertrophy of ventricle
4
Q
↓Arterial compliance→
• Aorta to arterioles stiffen = HTN
• Pressure must ↑ to stretch stiffer vessels
A
↑ Afterload→↑ Ventricular workload→
5
Q
Concentric Hypertrophy
• Why does concentric hypertrophy occur?
A
Atherosclerosis →↑conductance of pressure wave in aorta and arteries →Reflectant waves from arterioles and branch points returns to heart quicker than normal →↑resistance at end of systole→ hard for heart to overcome
6
Q
EKG changes for older
A
Left Ventricular Hypertrophy
7
Q
Cardiac output
• However demand may be down
• So ↓ not noticeable at rest
A
may ↓
8
Q
CO: Under stress, the ↓ is noticeable
A
when demand outstrips capacity
9
Q
CO stress noticed
A
- CHF
- MI
- Exercise
- Stress
- Surgery
10
Q
Chronotropy and Inotropy
Aging abd Beta
A
↓ responsiveness to β adrenergic agonists
11
Q
Aging and catecholamines
A
↓ response to catecholamines
12
Q
Aging and Beta Blockers
A
Response to β blockers is preserved
13
Q
Aging and Parasympathetic tone
A
Par. tone declines (less response to atropine and glyco)
14
Q
Sympathetic tone
A
↑ with aging
15
Q
Aging, Limited response to
A
glycopyrrolate and atropine
16
Q
Ability to cope with perioperative stress
A
is impaired
17
Q
↑ demand that cannot be met
A
• Sepsis or shivering may
18
Q
Elderly patients cannot compensate by______ and ______. They compensate by
A
increasing CO and HR. They compensate by vasoconstriction
19
Q
Baroreceptor Reflex :Stretch receptors
A
Impaired in aging
20
Q
Elderly prone to
A
orthostatic hypotension
21
Q
Baroreceptor Reflex exacerbated by
A
Exacerbated by diuretics and medications
22
Q
- One of the most important considerations
* Age related changes
A
↓ of elasticity of bony thorax
23
Q
Laryngeal structures change with age
A
Protective reflexes blunted
Aspiration more common
24
Q
Alveoli Become
A
dilated• ↑ compliance COPD-like
25
Aging and elasticity
↓ elasticity (Air trapping occurs d/t small
| airway closure)
26
Surface area change
decrased from 75m2 to 60m2 by 70 years
27
Changes in chest wall and muscle strength
Stiffened chest wall + ↓ muscle strength → ↓effective cough
28
Changes in parenchymal compliance
↑ parenchymal compliance
| Takes longer to passively exhale ↓ motor power
29
```
Inspiratory capacity (IC) is compromised because of the
combined effect of modest
```
↓ in total lung capacity (TLC) and modest ↑ in functional residual capacity (FRC)
30
Vital capacity (VC) and aging
↓ because of the ↓ in IC and the ↑ in residual volume
31
Additionally: Alveolar dead space
↑
32
PaO2 Declines from
95 to 73 by age 75 remaining stable.
33
What is the 70-70 rule
At 70 yo, normal PaO2 = 70 mm Hg
34
Hypoxic Pulmonary Vasoconstriction blunted by
stiffening lung parenchyma
35
Responses to hypoxemia
↓
36
Sensitivity to respiratory depression with non-narcotics
| like benzodiazepines.
↑
37
Electrolyte Impaired, handling of
Na handling
• Dehydration
• Impaired dilution
38
Hormones and aging
↓ response to ADH and Aldosterone
39
Disposition to these electrolytes disturbances
↑ hypokalemia and hyperkalemia
40
In older adults, As fxn is compromised,
drug clearance affected
41
Hepatic microsomes older adults
intact and functional
42
Hepatic mass____ with aging
↓ ; This impairs drug clearance
43
Most common cause for prolonged effects of narcs
Because Hepatic mass is decreased
44
Effect of aging: decrease hepatic mass
↓ the amount of plasma esterases
45
Drugs taken by elderly may affect fxn
Cimetidine affect benzodiazepine biotransformation
46
```
CNS effects of aging: Brain
• Most metabolically active
affected the most
• ↓Neurotransmitter
synthe
```
• Reduces brain size
47
CNS effects of aging: Brain
• Reduces brain size
48
Neuronal
↓ highly selective
49
Neuronal
↓ highly selective
50
Most _________affected the most
metabolically active
51
Neurotransmitter synthesis
↓
52
Generalized depletion of:
* acetylcholine
* Norepinephrine
* Tyrosine
* Dopamine
53
↑ activity of:
COMT – Catecholamine-o-methyl-transferase and
| MAO – Monoamine Oxidase• Break down neurotransmitters
54
Up regulation mechanisms
Depressed in elderly patients
55
Aging and response to neurotransmitters
Usually respond to ↓ in neurotransmitters
56
Consequence of ↓ cerebral mass
↓ CBF
57
Hyperventilation CO2 response
Hyperventilation CO2 response intact
58
Auto regulatory mechanisms
intact
59
Intelligence: Not affected by aging are
Long term memory, language skills and personality are not affected by aging
60
There may be a ↓ in
short term memory, hearing acuity, visual acuity and response times
61
Peripheral nervous system: meissner's
Exponential ↓ in meissner’s corpuscle
62
Evoked potentials and aging
• ↓
63
Aging and End plate
• ↓ number of end plates
64
Aging number of receptors
• However ↑ number of receptors
65
Therefore no change in NMB doses why?
```
↓ number of end plates
• However ↑ number of receptors
• Negates ↓
• Therefore no change in NMB
doses
```
66
Threshold intensities
up for pain
67
Autonomic Nervous System
Paradoxically in_______
Marked ↓ in
hyper adrenergic state
| • in β adrenergic response
68
NE levels at
2 – 3 times normal
69
NE levels at
2 – 3 times normal
70
Adrenal tissue mass changes
declines
71
Autonomic reflexes and aging
impaired in the elderly
72
Elastin and collagen and aging
Loss of elastin
| Increased collagen
73
Systolic function and aging
Autonomic Nervous System – cont.
74
Anesthetic techniques that blunt the nervous system may cause
greater changes in the elderly i.e. spinal/ epidural anesthetics
75
Elderly patients with CHF with
high adrenergic tone could have catastrophic effects under anesthesia
76
Baroreceptor and aging
Barosensitivity decreases
77
Body heat
• ↓ in production
78
Time to return patient to normal temperature
↑ with ↑ age
79
Insulin and aging
↓ Sensitivity to Insulin; Increase resistance to insulin
80
Plasma NE is
Increased
81
Elderly at ↑ risk for
inadvertent intra-operative hypothermia
82
• Oxygen consumption is
↓
83
• Heat production
↓
84
Aging and ADH
Decreased Response to ADH
85
ALDOSTERONE and aging
DECREASED ability to conserve sodium, --> risk for dehydration
86
All decreased, Not affected
Alpha 1 glycoprotein (increased
87
First pass metabolism is
decreased
88
Anesthetics
Increased VD of propofol
| Faster induction wtih sevoflurane
89
Rate of recovery from volatile anesthetis is
Decreased
90
Closing capacity and aging
Increase closing
91
3 changes because of increased Closing capacity
VQ matching
Decreased PaO2
Increased Dead space
92
TLC stays
Same
93
At age does CLOSING CAPACITY EXCEED FRC while laying supine?
45 years
94
Most significant risk factor for Cancer
age
95
Best describe post op cognitive dysfunction
Following cardiac surgery
| The most significant risk factor is increasing age.
96
2 increased in elderly
Pulse pressure
| NE plasma concentration
97
Patient with Parkinson's showing signs of EPS
Diphenhydramine
98
Lung compliance is
Increased
99
Minute ventilation is
Increased
100
Calculating MAC 40 decrease
Mac x 0.94 ^(# of decade decrease)
101
Bolus doesn't go to sleep as fast why?
Slower rate of transfer to target organs
102
Desflurane
Can mimic sympathetic, May increase BP
103
Most important cause of prolonged drug activity in elderly is
DECREASE in LIVER MASS
104
Glomeruli and age
1/2 glomeruli decrease by 80 years old
105
Aging and insulin
Decrease insulin secretion, with increase resistance
106
Aging does production of insulin
NO change
107
Why does MAC decrease
Brain is smaller
108
AVOID those drugs in Parkinson
DROPERIDOL and METOCLOPRAMIDE
109
Good for premedication and intraop sedation for parkisons
Diphenhydramine
110
Alveoli changes
overdistended alveoli
111
Small airway changes
Collapse because of distended alveoli
112
Sodium changes s DIH
Diluting capacity decrease
Impaired NA handling
Concentrating ability decrease
Changes put at risk for dehydration and fluid overload
113
Liver mass and hepatic blood flow
decrease
114
Hepatic function decline in
proportion to the decrease in liver mass
115
Diastolic DYSFUNCTION not equivalent to ?
| What happens to filling pressure?
FAILURE
| Filling pressure increase
116
Hypercapnia and hypoxia response is
Decreased n
117
BUN _____. Cr is ______. Creatininge clearance
increase; UNCHANGED; DECREASED
118
Neuroendocrine response to stress is
preserved or only slighly decreased
119
Use drugs such as ________why?
Atracurium, or cisatracurium, NOt dependent on hepatic or renal function or flow
120
The reduce Vd for water soluble drugs can lead to
Greater plasma concentrations
121
The increase Vd for lipid soluble drugs can
decrease their plasma concentration
122
Is the dose of succinylcholine affected by age ?
Best bet for NDNMB
NO,
vec and roc affected due to hepatic excretion and aging associated with loss of liver mass
Atra and cisa
123
Associated with increase post op delierium
Benzo and anticholinergics
