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Erschienen in: Current Geriatrics Reports 3/2017

14.07.2017 | Surgical Care for the Geriatric Patient (F Luchette and R Gonzalez, Section Editors)

Anesthesia Considerations for the Geriatric Patient

verfasst von: Steven B. Edelstein, Jonathan E. Metry

Erschienen in: Current Geriatrics Reports | Ausgabe 3/2017

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Abstract

Purpose of Review

This review discusses the pathophysiology and medical challenges facing the provider when dealing with the geriatric patient population. We discuss not only physiologic issues but also cognitive and social problems that complicate the management of these patients.

Recent Findings

The phenotype of frailty adversely affects patient outcomes. Assuming the physical condition of the patient is not impaired; age alone is not a predictor of poor outcomes, even in complex surgical cases. There is little evidence that one approach of anesthesia is superior to another in regard to outcomes, though there may be some benefits in choosing regional anesthesia techniques.

Summary

The geriatric patient population continues to grow and we will see more patients at the extremes of age (>80) presenting not only for urgent/emergent but also for elective, non-palliative procedures. Ongoing multicenter trials are underway to help understand the implications of anesthesia choice in these patients.
Literatur
3.
Zurück zum Zitat Dodds C, Foo I, Jones K, et al. Peri-operative care of elderly patients—urgent need for change: a consensus statement to provide guidance for the non-specialist anaesthetists. Perioper Med (Lond). 2013;2(1):2–6. doi:10.1186/2047-0525-2-6.CrossRef Dodds C, Foo I, Jones K, et al. Peri-operative care of elderly patients—urgent need for change: a consensus statement to provide guidance for the non-specialist anaesthetists. Perioper Med (Lond). 2013;2(1):2–6. doi:10.​1186/​2047-0525-2-6.CrossRef
6.
Zurück zum Zitat Scandrett KG, Zuberbraun BS, Peitzman AB. Operative risk stratification in the older adult. Surg Clin N Am. 2015;95:149–72.CrossRef Scandrett KG, Zuberbraun BS, Peitzman AB. Operative risk stratification in the older adult. Surg Clin N Am. 2015;95:149–72.CrossRef
7.
Zurück zum Zitat Borson S, Scanlan J, Brush M, et al. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. In J Geriatr Psychiatry. 2000;15(11):1021–17.CrossRef Borson S, Scanlan J, Brush M, et al. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. In J Geriatr Psychiatry. 2000;15(11):1021–17.CrossRef
8.
Zurück zum Zitat Plassman BL, Langa KM, Fischer GG, et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2009;148:427–34.CrossRef Plassman BL, Langa KM, Fischer GG, et al. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2009;148:427–34.CrossRef
12.
Zurück zum Zitat Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M145–56.CrossRef Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M145–56.CrossRef
13.
Zurück zum Zitat • Murthy S, Hepner DL, Cooper Z, Bader AM, Neuman MD. Controversies in anaesthesia for noncardiac surgery in older adults. BJA. 2015;115(S2):ii15–25. doi:10.1093/bja/aev396. This summary article addresses many of the clinical scenarios that affect the geriatric patient and future research projects that are underway CrossRefPubMed • Murthy S, Hepner DL, Cooper Z, Bader AM, Neuman MD. Controversies in anaesthesia for noncardiac surgery in older adults. BJA. 2015;115(S2):ii15–25. doi:10.​1093/​bja/​aev396. This summary article addresses many of the clinical scenarios that affect the geriatric patient and future research projects that are underway CrossRefPubMed
14.
Zurück zum Zitat Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;201:901–8.CrossRef Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;201:901–8.CrossRef
15.
Zurück zum Zitat Fillit H, Butler RN. The frailty identity crisis. JAGS. 2009;57:348–52.CrossRef Fillit H, Butler RN. The frailty identity crisis. JAGS. 2009;57:348–52.CrossRef
16.
Zurück zum Zitat McEwen BS. Protective and damaging effects of stress mediators: central role of the brain. Dialog Clin Neurosci. 2006;8:367–81. McEwen BS. Protective and damaging effects of stress mediators: central role of the brain. Dialog Clin Neurosci. 2006;8:367–81.
18.
Zurück zum Zitat Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453–66.CrossRef Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453–66.CrossRef
20.
Zurück zum Zitat Castillo JG, Silvay G, Chikwe J. Cardiac anesthesia and surgery in geriatric patients: epidemiology, current surgical outcomes, and future directions. HSR Proc Intensive Care Cardiovasc Anesth. 2009;1(2):6–19.PubMedPubMedCentral Castillo JG, Silvay G, Chikwe J. Cardiac anesthesia and surgery in geriatric patients: epidemiology, current surgical outcomes, and future directions. HSR Proc Intensive Care Cardiovasc Anesth. 2009;1(2):6–19.PubMedPubMedCentral
22.
Zurück zum Zitat Bignami E, Biondi-Zoccai G, Landoni G, Fochi O, et al. Volatile anesthetics reduce mortality in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23(5):594–9.CrossRef Bignami E, Biondi-Zoccai G, Landoni G, Fochi O, et al. Volatile anesthetics reduce mortality in cardiac surgery. J Cardiothorac Vasc Anesth. 2009;23(5):594–9.CrossRef
24.
Zurück zum Zitat Bristow MR. Mechanism of action of beta-blocking agents in heart failure. Am J Cardiol. 1997;80:26L–40L.CrossRef Bristow MR. Mechanism of action of beta-blocking agents in heart failure. Am J Cardiol. 1997;80:26L–40L.CrossRef
25.
Zurück zum Zitat Berdjis N, Hakenberg OW, Novotny V, et al. Treating renal cell cancer in the elderly. BJU Int. 2005;97:703–5.CrossRef Berdjis N, Hakenberg OW, Novotny V, et al. Treating renal cell cancer in the elderly. BJU Int. 2005;97:703–5.CrossRef
27.
Zurück zum Zitat Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117:72–92.CrossRef Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117:72–92.CrossRef
29.
Zurück zum Zitat Peschman J, Vrasel KJ. End of life care of the geriatric surgical patient. Surg Clin N Am. 2015;95:191–202.CrossRef Peschman J, Vrasel KJ. End of life care of the geriatric surgical patient. Surg Clin N Am. 2015;95:191–202.CrossRef
31.
Zurück zum Zitat Knipe M, Hardman JG. Past, present, and future of ‘do not attempt resuscitation’ orders in the perioperative period. Br J Anaesth. 2013;111(6):861–3.CrossRef Knipe M, Hardman JG. Past, present, and future of ‘do not attempt resuscitation’ orders in the perioperative period. Br J Anaesth. 2013;111(6):861–3.CrossRef
32.
Zurück zum Zitat Margolis JO, McGrath BJ, Kussin PS, et al. Do not resuscitate (DNR) orders during surgery; ethical foundations for institutional polices in the United States. Anes Analg. 1995;80(4):806–9. Margolis JO, McGrath BJ, Kussin PS, et al. Do not resuscitate (DNR) orders during surgery; ethical foundations for institutional polices in the United States. Anes Analg. 1995;80(4):806–9.
Metadaten
Titel
Anesthesia Considerations for the Geriatric Patient
verfasst von
Steven B. Edelstein
Jonathan E. Metry
Publikationsdatum
14.07.2017
Verlag
Springer US
Erschienen in
Current Geriatrics Reports / Ausgabe 3/2017
Elektronische ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-017-0206-0

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