75 Questions
The chest wall compliance ________
decreases
Minute ventilation ________ in the elderly due to increased dead space
increases
Loss of muscle tone in airway predisposes to upper airway ________
obstruction
Elderly are predisposed to postop hypoxia due to less effective ________ and swallowing
coughing
Respiratory changes in aging include emphysema, chronic bronchitis, ________, lung cancer, and TB
PNA
An edentulous patient poses a challenge during anesthesia due to difficulty in ________
BMV
Arthritis of the TMJ or cervical spine poses a challenge in anesthesia related to ________ and airway
position
To prevent perioperative hypoxia, actions like preoxygenation, higher FiO2, more PEEP, and pulmonary ________ can be taken
recruitment
Anesthetic considerations: Preop Vd? _______ (increased)
increased
Anesthetic considerations: Preop age > 70 caution use of _______ (Versed)
Versed
Anesthetic techniques: preferential use of spinal/epidural and regional over _______ (MAC)
MAC
Perioperative: Drug to try to avoid? _______ (anticholinergics)
anticholinergics
Perioperative: Inhalational agents? Reduced _______ (concentration)
concentration
Postop Volume of distribution: increased _______ (fat)
fat
Postop: anesthetics will have increased Vd, reduce doses of _______ (propofol and etomidate)
propofol and etomidate
Confusion Assessment Method (CAM) developed by Dr.Sharon K.Inouye, MD, is a tool for delirium _______ (assessment)
assessment
By age 80, 50% of nephrons are lost due to ________.
aging
Renal function declines with age, leading to decreased renal blood flow and ________.
GFR
Elderly patients with renal impairment are at risk of fluid overload, electrolyte imbalances, and accumulation of metabolites due to decreased ________.
elimination
Surgery and anesthesia in elderly patients result in increased glucose levels and insulin resistance, leading to increased ________ requirements during surgery.
insulin
Hepatic changes in aging individuals include decreased liver size, hepatic blood flow, and albumin production, as well as age-related redistribution of ________.
perfusion
Elderly individuals have decreased basal metabolism, leading to decreased heat production and autonomic ________.
vasoconstriction
GI changes in aging individuals include decreased esophageal and intestinal motility, and decreased gastroesophageal ________ tone.
sphincter
Elderly patients undergoing surgery are at increased risk of surgical wound infection and coagulopathy, leading to increased ________ loss.
blood
Decrease dose & titrate slowly-propofol leads to ______
hypotension
SUX: Slower onset (40%) o NDMRs depending on renal excretion are ______
prolonged
Atracuruim is unaffected by ______
age
NDMRs doses are changed little by the process of aging ______
itself
How about ______?
Neostigmine
No technique has shown to be superior for the ______
elderly
Some evidence supports that older pts have better prognosis if the surgery is done under ______
local
Narrowing of intervertebral spaces and osteophytic growth suggests that LA less likely to spread outward and more likely to spread upward in the spinal canal o Increased permeability produces more rapid onset o Reduced clearance and prolonged elimination ½ life leads to ______ conc.
toxic
To properly guard against this occurrence and costly outcome, your peri-operative anesthetic plan should ______: o avoid anticholinergics if possible o reduce the dose of inhalation agents o avoid narcotics if possible o Alfenta/Sufenta used commonly → quicker off Geriatric Syndromes Osteoporosis Osteoarthritis, RA Parkinson’s Disease Dementia Osteoporosis Microarchitectural deterioration of bone o ↓ bone density o ↑ bone fragility o Susceptibility to fractures May be asymptomatic until a fracture occurs Loss of height/increasing kyphosis-secondary to vertebral fractures Women with fractures -50% spend time in a nursing home Peak incidence is 70 years old Associated risk factors: o o o o o -Estrogen deficiency -Increased alcohol consumption, smoker -Cancer -Calcium deficiency -Long term steroid therapy Osteoarthritis Non-pharmacologic intervention(cornerstone) Patient education, PT and OT Decrease in joint stress Acetaminophen and NSAIDs Muscle relaxants-spasms Intra-articular glucocorticoid injections Narcotics and arthroplasty Cervical OA: o Difficult intubation ▪ -Decreased mobility airway ▪ -TMJ arthritis ▪ -Cervical spine-mobility and stability ▪ -Decrease glottic opening o Consider flexion/extension x-rays if concern o Easy to fracture Parkinson’s Disease Characterized by progressive depletion dopaminergic neurons of substantia nigra from basal ganglia Age is most consistent factor o 3% of population older than 65 o 50% of people older than 85 Clinical signs when approximately 80% of dopaminergic activity is lost Imbalance between the inhibitory action of dopamine and excitatory action of acetylcholine Imbalance leads to classic triad Triad: rigidity, resting tremor, bradykinesia Anesthesia considerations: o Aspiration prophylaxis o Monitoring of respiratory function o Administer drugs as close to schedule as possible o Drugs should to avoid: phenothiazines, butyrophenones (droperidol), metoclopramide o Diphenhydramine can be effective to counter drug-induced extra-pyramidal effects o ANS dysfunction-hemodynamic monitoring as needed What is deep brain stimulation?
include
To properly guard against this occurrence and costly outcome, your peri-operative anesthetic plan should ______: o avoid anticholinergics if possible o reduce the dose of inhalation agents o avoid narcotics if possible o Alfenta/Sufenta used commonly → quicker off Geriatric Syndromes Osteoporosis Osteoarthritis, RA Parkinson’s Disease Dementia Osteoporosis Microarchitectural deterioration of bone o ↓ bone density o ↑ bone fragility o Susceptibility to fractures May be asymptomatic until a fracture occurs Loss of height/increasing kyphosis-secondary to vertebral fractures Women with fractures -50% spend time in a nursing home Peak incidence is 70 years old Associated risk factors: o o o o o -Estrogen deficiency -Increased alcohol consumption, smoker -Cancer -Calcium deficiency -Long term steroid therapy Osteoarthritis Non-pharmacologic intervention(cornerstone) Patient education, PT and OT Decrease in joint stress Acetaminophen and NSAIDs Muscle relaxants-spasms Intra-articular glucocorticoid injections Narcotics and arthroplasty Cervical OA: o Difficult intubation ▪ -Decreased mobility airway ▪ -TMJ arthritis ▪ -Cervical spine-mobility and stability ▪ -Decrease glottic opening o Consider flexion/extension x-rays if concern o Easy to fracture Parkinson’s Disease Characterized by progressive depletion dopaminergic neurons of substantia nigra from basal ganglia Age is most consistent factor o 3% of population older than 65 o 50% of people older than 85 Clinical signs when approximately 80% of dopaminergic activity is lost Imbalance between the inhibitory action of dopamine and excitatory action of acetylcholine Imbalance leads to classic triad Triad: rigidity, resting tremor, bradykinesia Anesthesia considerations: o Aspiration prophylaxis o Monitoring of respiratory function o Administer drugs as close to schedule as possible o Drugs should to avoid: phenothiazines, butyrophenones (droperidol), metoclopramide o Diphenhydramine can be effective to counter drug-induced extra-pyramidal effects o ANS dysfunction-hemodynamic monitoring as needed What is deep brain stimulation?
o
To properly guard against this occurrence and costly outcome, your peri-operative anesthetic plan should ______ anticholinergics if possible o reduce the dose of inhalation agents o avoid narcotics if possible o Alfenta/Sufenta used commonly → quicker off Geriatric Syndromes Osteoporosis Osteoarthritis, RA Parkinson’s Disease Dementia Osteoporosis Microarchitectural deterioration of bone o ↓ bone density o ↑ bone fragility o Susceptibility to fractures May be asymptomatic until a fracture occurs Loss of height/increasing kyphosis-secondary to vertebral fractures Women with fractures -50% spend time in a nursing home Peak incidence is 70 years old Associated risk factors: o o o o o -Estrogen deficiency -Increased alcohol consumption, smoker -Cancer -Calcium deficiency -Long term steroid therapy Osteoarthritis Non-pharmacologic intervention(cornerstone) Patient education, PT and OT Decrease in joint stress Acetaminophen and NSAIDs Muscle relaxants-spasms Intra-articular glucocorticoid injections Narcotics and arthroplasty Cervical OA: o Difficult intubation ▪ -Decreased mobility airway ▪ -TMJ arthritis ▪ -Cervical spine-mobility and stability ▪ -Decrease glottic opening o Consider flexion/extension x-rays if concern o Easy to fracture Parkinson’s Disease Characterized by progressive depletion dopaminergic neurons of substantia nigra from basal ganglia Age is most consistent factor o 3% of population older than 65 o 50% of people older than 85 Clinical signs when approximately 80% of dopaminergic activity is lost Imbalance between the inhibitory action of dopamine and excitatory action of acetylcholine Imbalance leads to classic triad Triad: rigidity, resting tremor, bradykinesia Anesthesia considerations: o Aspiration prophylaxis o Monitoring of respiratory function o Administer drugs as close to schedule as possible o Drugs should to avoid: phenothiazines, butyrophenones (droperidol), metoclopramide o Diphenhydramine can be effective to counter drug-induced extra-pyramidal effects o ANS dysfunction-hemodynamic monitoring as needed What is deep brain stimulation?
avoid
What are the anesthesia considerations for patients with Parkinson's Disease?
Aspiration prophylaxis, monitoring of respiratory function, avoiding certain drugs like phenothiazines
Why do elderly patients undergoing surgery have an increased risk of surgical wound infection and coagulopathy?
Due to age-related changes that affect the immune system and blood clotting factors.
What are some of the GI changes seen in aging individuals?
Decreased esophageal and intestinal motility, decreased gastroesophageal sphincter tone.
How do elderly patients predispose to postoperative hypoxia?
Due to less effective cough reflex and swallowing mechanisms.
What are the respiratory changes seen in aging individuals?
Emphysema, chronic bronchitis, lung cancer, and TB.
How does aging affect hepatic function?
Decreased liver size, hepatic blood flow, and albumin production.
Why should anesthetic considerations be cautious in elderly patients with renal impairment?
Due to the risk of fluid overload, electrolyte imbalances, and metabolite accumulation.
What are the challenges posed by an edentulous patient during anesthesia?
Difficulty in airway management and securing proper ventilation.
What are two causes of death related to aspiration in elderly patients?
Acidic burning of the lungs and obstruction
What are the CNS changes in elderly patients undergoing surgery?
Decreased brain mass, cerebral blood flow, synthesis of neurotransmitters, neurotransmitter receptors, and increased sensitivity to anesthetic agents.
What is Postoperative Cognitive Dysfunction (POCD) characterized by?
Deterioration of intellectual function presenting as impaired memory or concentration.
What is the most common form of perioperative CNS dysfunction in elderly surgical patients?
Postoperative Delirium (POD)
What is the pathophysiology behind Postoperative Delirium (POD)?
Excess of dopamine and neuroinflammatory process triggered by surgical stress.
What are some risk factors for developing Postoperative Delirium (POD)?
Type of surgery, pre-op cognitive function, age over 60, and baseline function.
What is Osteoporosis characterized by?
Microarchitectural deterioration of bone, decreased bone density, and increased bone fragility.
What are the classic signs of Parkinson's Disease?
Rigidity, resting tremor, and bradykinesia.
What are the two main factors that contribute to the risk of post-op acute renal failure in elderly patients with renal impairment?
decreased renal blood flow and GFR
What are the main concerns with elderly patients with renal impairment during anesthesia?
risk of fluid overload (CHF) and electrolyte imbalances
Why do elderly patients undergoing surgery have increased insulin requirements?
increased insulin resistance with age
What is the main reason behind the loss of 50% of nephrons by age 80?
age-related decrease in renal mass and functioning glomeruli
What are the common hepatic changes in aging individuals?
decreased liver size, hepatic blood flow, and albumin production
Why do elderly individuals have a decreased basal metabolism?
decreased heat production
What are the GI changes commonly observed in aging individuals?
decreased esophageal/intestinal motility and GE sphincter tone
How does aging affect renal function?
decline in renal blood flow and GFR
What are three primary factors associated with perioperative risks in older adults?
Reduced reserve capacity and functional decline, Comorbidities (atypical disease presentation), Untoward reactions to medications
How does body composition change with aging?
Lean body mass decreases, Skeletal muscle decreases, Total body water decreases, Tissue elasticity decreases, Body fat increases
What is the primary effect of decreased plasma albumin levels in the elderly?
Decreased plasma albumin levels affect the protein binding of drugs.
What age-related change affects the Volume of distribution (Vd) of drugs in the elderly?
Increased Vd of lipophilic drugs and decreased Vd of hydrophilic drugs.
Why is the decrease in plasma albumin levels an anesthetic concern?
Decreased plasma albumin levels can affect the protein binding of anesthetic agents.
What is the classic triad of symptoms in Parkinson's Disease?
Rigidity, resting tremor, bradykinesia
What are some key anesthesia considerations for patients with Parkinson's Disease?
Aspiration prophylaxis, Monitoring of respiratory function, Avoiding certain drugs like phenothiazines and butyrophenones
What is the primary concern related to osteoporosis in elderly patients during anesthesia?
Increased susceptibility to fractures poses a significant risk during anesthesia.
What is the effect of aging on neuromuscular blocking agents (NDMRs) depending on renal excretion?
Prolonged
Why is the dose of local anesthetics suggested to be decreased in epidural anesthesia for the elderly?
Increased permeability of extraneural tissues
What are the clinical signs of Parkinson's Disease when approximately 80% of dopaminergic activity is lost?
Rigidity, resting tremor, bradykinesia
Why should phenothiazines, butyrophenones, and metoclopramide be avoided in elderly patients during anesthesia?
Extra-pyramidal effects
What is the effect of aging on renal function?
Decreased renal blood flow
Why are elderly patients at increased risk of surgical wound infection and coagulopathy during surgery?
Increased blood loss
What are the challenges posed by arthritis of the TMJ or cervical spine in anesthesia?
Difficult intubation and airway
What is the effect of aging on basal metabolism in elderly individuals?
Decreased heat production
Explore the renal changes associated with narcotics use and aging, including decreased renal blood flow, glomerular filtration rate (GFR), renal mass, and tubular function. Learn about conditions like diabetic nephropathy, hypertensive nephropathy, and anesthetic considerations for individuals with compromised renal function.
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