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Systemic Changes Flashcards

1
Q

Systolic hypertension

A

Progressive, gender independent

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2
Q

Systolic HTN is Due to

A

fibrosis of elastic tissues which Raises ventricular wall

tensions, workload

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3
Q

Workload increase Causes

A

hypertrophy of ventricle

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4
Q

↓Arterial compliance→
• Aorta to arterioles stiffen = HTN
• Pressure must ↑ to stretch stiffer vessels

A

↑ Afterload→↑ Ventricular workload→

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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

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6
Q

EKG changes for older

A

Left Ventricular Hypertrophy

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7
Q

Cardiac output
• However demand may be down
• So ↓ not noticeable at rest

A

may ↓

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8
Q

CO: Under stress, the ↓ is noticeable

A

when demand outstrips capacity

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9
Q

CO stress noticed

A
  • CHF
  • MI
  • Exercise
  • Stress
  • Surgery
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10
Q

Chronotropy and Inotropy

Aging abd Beta

A

↓ responsiveness to β adrenergic agonists

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11
Q

Aging and catecholamines

A

↓ response to catecholamines

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12
Q

Aging and Beta Blockers

A

Response to β blockers is preserved

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13
Q

Aging and Parasympathetic tone

A

Par. tone declines (less response to atropine and glyco)

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14
Q

Sympathetic tone

A

↑ with aging

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15
Q

Aging, Limited response to

A

glycopyrrolate and atropine

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16
Q

Ability to cope with perioperative stress

A

is impaired

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17
Q

↑ demand that cannot be met

A

• Sepsis or shivering may

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18
Q

Elderly patients cannot compensate by______ and ______. They compensate by

A

increasing CO and HR. They compensate by vasoconstriction

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19
Q

Baroreceptor Reflex :Stretch receptors

A

Impaired in aging

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20
Q

Elderly prone to

A

orthostatic hypotension

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21
Q

Baroreceptor Reflex exacerbated by

A

Exacerbated by diuretics and medications

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22
Q
  • One of the most important considerations

* Age related changes

A

↓ of elasticity of bony thorax

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23
Q

Laryngeal structures change with age

A

Protective reflexes blunted

Aspiration more common

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24
Q

Alveoli Become

A

dilated• ↑ compliance COPD-like

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25
Q

Aging and elasticity

A

↓ elasticity (Air trapping occurs d/t small

airway closure)

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26
Q

Surface area change

A

decrased from 75m2 to 60m2 by 70 years

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27
Q

Changes in chest wall and muscle strength

A

Stiffened chest wall + ↓ muscle strength → ↓effective cough

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28
Q

Changes in parenchymal compliance

A

↑ parenchymal compliance

Takes longer to passively exhale ↓ motor power

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29
Q 
Inspiratory capacity (IC) is compromised because of the
combined effect of modest
A

↓ in total lung capacity (TLC) and modest ↑ in functional residual capacity (FRC)

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30
Q

Vital capacity (VC) and aging

A

↓ because of the ↓ in IC and the ↑ in residual volume

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31
Q

Additionally: Alveolar dead space

A

↑

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32
Q

PaO2 Declines from

A

95 to 73 by age 75 remaining stable.

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33
Q

What is the 70-70 rule

A

At 70 yo, normal PaO2 = 70 mm Hg

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34
Q

Hypoxic Pulmonary Vasoconstriction blunted by

A

stiffening lung parenchyma

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35
Q

Responses to hypoxemia

A

↓

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36
Q

Sensitivity to respiratory depression with non-narcotics

like benzodiazepines.

A

↑

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37
Q

Electrolyte Impaired, handling of

A

Na handling
• Dehydration
• Impaired dilution

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38
Q

Hormones and aging

A

↓ response to ADH and Aldosterone

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39
Q

Disposition to these electrolytes disturbances

A

↑ hypokalemia and hyperkalemia

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40
Q

In older adults, As fxn is compromised,

A

drug clearance affected

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41
Q

Hepatic microsomes older adults

A

intact and functional

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42
Q

Hepatic mass____ with aging

A

↓ ; This impairs drug clearance

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43
Q

Most common cause for prolonged effects of narcs

A

Because Hepatic mass is decreased

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44
Q

Effect of aging: decrease hepatic mass

A

↓ the amount of plasma esterases

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45
Q

Drugs taken by elderly may affect fxn

A

Cimetidine affect benzodiazepine biotransformation

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46
Q 
CNS effects of aging: Brain 
• Most metabolically active
affected the most
• ↓Neurotransmitter
synthe
A

• Reduces brain size

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47
Q

CNS effects of aging: Brain

A

• Reduces brain size

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48
Q

Neuronal

A

↓ highly selective

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49
Q

Neuronal

A

↓ highly selective

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50
Q

Most _________affected the most

A

metabolically active

51
Q

Neurotransmitter synthesis

52
Q

Generalized depletion of:

A
  • acetylcholine
  • Norepinephrine
  • Tyrosine
  • Dopamine
53
Q

↑ activity of:

A

COMT – Catecholamine-o-methyl-transferase and

MAO – Monoamine Oxidase• Break down neurotransmitters

54
Q

Up regulation mechanisms

A

Depressed in elderly patients

55
Q

Aging and response to neurotransmitters

A

Usually respond to ↓ in neurotransmitters

56
Q

Consequence of ↓ cerebral mass

57
Q

Hyperventilation CO2 response

A

Hyperventilation CO2 response intact

58
Q

Auto regulatory mechanisms

59
Q

Intelligence: Not affected by aging are

A

Long term memory, language skills and personality are not affected by aging

60
Q

There may be a ↓ in

A

short term memory, hearing acuity, visual acuity and response times

61
Q

Peripheral nervous system: meissner’s

A

Exponential ↓ in meissner’s corpuscle

62
Q

Evoked potentials and aging

63
Q

Aging and End plate

A

• ↓ number of end plates

64
Q

Aging number of receptors

A

• However ↑ number of receptors

65
Q

Therefore no change in NMB doses why?

A 
↓ number of end plates
• However ↑ number of receptors
• Negates ↓
• Therefore no change in NMB
doses
66
Q

Threshold intensities

A

up for pain

67
Q

Autonomic Nervous System
Paradoxically in_______
Marked ↓ in

A

hyper adrenergic state

• in β adrenergic response

68
Q

NE levels at

A

2 – 3 times normal

69
Q

NE levels at

A

2 – 3 times normal

70
Q

Adrenal tissue mass changes

71
Q

Autonomic reflexes and aging

A

impaired in the elderly

72
Q

Elastin and collagen and aging

A

Loss of elastin

Increased collagen

73
Q

Systolic function and aging

A

Autonomic Nervous System – cont.

74
Q

Anesthetic techniques that blunt the nervous system may cause

A

greater changes in the elderly i.e. spinal/ epidural anesthetics

75
Q

Elderly patients with CHF with

A

high adrenergic tone could have catastrophic effects under anesthesia

76
Q

Baroreceptor and aging

A

Barosensitivity decreases

77
Q

Body heat

A

• ↓ in production

78
Q

Time to return patient to normal temperature

A

↑ with ↑ age

79
Q

Insulin and aging

A

↓ Sensitivity to Insulin; Increase resistance to insulin

80
Q

Plasma NE is

81
Q

Elderly at ↑ risk for

A

inadvertent intra-operative hypothermia

82
Q

• Oxygen consumption is

83
Q

• Heat production

84
Q

Aging and ADH

A

Decreased Response to ADH

85
Q

ALDOSTERONE and aging

A

DECREASED ability to conserve sodium, –> risk for dehydration

86
Q

All decreased, Not affected

A

Alpha 1 glycoprotein (increased

87
Q

First pass metabolism is

88
Q

Anesthetics

A

Increased VD of propofol

Faster induction wtih sevoflurane

89
Q

Rate of recovery from volatile anesthetis is

90
Q

Closing capacity and aging

A

Increase closing

91
Q

3 changes because of increased Closing capacity

A

VQ matching
Decreased PaO2
Increased Dead space

92
Q

TLC stays

93
Q

At age does CLOSING CAPACITY EXCEED FRC while laying supine?

94
Q

Most significant risk factor for Cancer

95
Q

Best describe post op cognitive dysfunction

A

Following cardiac surgery

The most significant risk factor is increasing age.

96
Q

2 increased in elderly

A

Pulse pressure

NE plasma concentration

97
Q

Patient with Parkinson’s showing signs of EPS

A

Diphenhydramine

98
Q

Lung compliance is

99
Q

Minute ventilation is

100
Q

Calculating MAC 40 decrease

A

Mac x 0.94 ^(# of decade decrease)

101
Q

Bolus doesn’t go to sleep as fast why?

A

Slower rate of transfer to target organs

102
Q

Desflurane

A

Can mimic sympathetic, May increase BP

103
Q

Most important cause of prolonged drug activity in elderly is

A

DECREASE in LIVER MASS

104
Q

Glomeruli and age

A

1/2 glomeruli decrease by 80 years old

105
Q

Aging and insulin

A

Decrease insulin secretion, with increase resistance

106
Q

Aging does production of insulin

107
Q

Why does MAC decrease

A

Brain is smaller

108
Q

AVOID those drugs in Parkinson

A

DROPERIDOL and METOCLOPRAMIDE

109
Q

Good for premedication and intraop sedation for parkisons

A

Diphenhydramine

110
Q

Alveoli changes

A

overdistended alveoli

111
Q

Small airway changes

A

Collapse because of distended alveoli

112
Q

Sodium changes s DIH

A

Diluting capacity decrease
Impaired NA handling
Concentrating ability decrease

Changes put at risk for dehydration and fluid overload

113
Q

Liver mass and hepatic blood flow

114
Q

Hepatic function decline in

A

proportion to the decrease in liver mass

115
Q

Diastolic DYSFUNCTION not equivalent to ?

What happens to filling pressure?

A

FAILURE

Filling pressure increase

116
Q

Hypercapnia and hypoxia response is

A

Decreased n

117
Q

BUN _____. Cr is ______. Creatininge clearance

A

increase; UNCHANGED; DECREASED

118
Q

Neuroendocrine response to stress is

A

preserved or only slighly decreased

119
Q

Use drugs such as ________why?

A

Atracurium, or cisatracurium, NOt dependent on hepatic or renal function or flow

120
Q

The reduce Vd for water soluble drugs can lead to

A

Greater plasma concentrations

121
Q

The increase Vd for lipid soluble drugs can

A

decrease their plasma concentration

122
Q

Is the dose of succinylcholine affected by age ?

Best bet for NDNMB

A

NO,
vec and roc affected due to hepatic excretion and aging associated with loss of liver mass
Atra and cisa

123
Q

Associated with increase post op delierium

A

Benzo and anticholinergics

SNRAObPedGer (25 decks)

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