Exam 1 Anesthesia for Elderly

Question 1

Anesthetic risk increased d/t 2 factors

Answer 1

1. increased prevalence of age-related concomitant disease

2. decrease in basic organ fxn

Question 2

____ age is more important than _____ age

Answer 2

physiologic age is more important than chronological age

Question 3

Geriatric anesthesia

Answer 3

65 years and +

Question 4

Multiple coexisting diseases are the ____ not the ____

Answer 4

rule, not the exception

Question 5

Leading list of concomitant disease

Answer 5

HTN, atherosclerosis, renal dx

Question 6

CVS system effects - patho of aging

Answer 6

CO decreases 1%/year after 30y/o
Decreased: Adenoreceptor sensitivity, Cardiac reserve, HR/coronary flow/response to stress
PVR/SBP increase

Question 7

Nervous system effects - patho of aging

Answer 7

increased incidence of: postop confusion, delirium, sensitivity to anesthetic agents
Loss of neuronal substance + reduction in neuronal density
Regional decrease in neurotransmitters

Question 8

Postop delirium - strategies to reduce incidence

Answer 8

• Periop monitoring (ICU/monitored bed)
• avoid hypoxemia, hypotension
• correct fluid/electrolytes
• use VAs w/ low blood/gas + tissue/blood solubility coefficients
• AVOID anticholinergics!!!

Question 9

POD

Answer 9

Postop delirium

Question 10

Ventilatory system effects - patho of aging

Answer 10

Decreased: static lung volume, max exp flow, pulm static recoil, sensititvity to airway receptors, protective airway ability, baseline PaO2
Increased: A-a gradient + VQ mismatch
Less able to protect airway, clear secretions: aspiration/postop atelectasis

Question 11

Liver changes - patho of aging

Answer 11

metabolism hindered (oxidation, glucuronidation) - increased DOA for lipid Rx

Question 12

> 65 y/o, what change occurs to liver?

Answer 12

Liver blood flow decreases by 40%

Question 13

Renal changes - patho of aging

Answer 13

renal clearance reduced, distal tubule fxn impaired

Question 14

Serum creatinine

Answer 14

Remains normal d/t reduced renal excretion + less skeletal muscle mass
(creat. clearance = more accurate)

Question 15

Maintain UOP at ____

Answer 15

0.5 mL/kg/hr to protect kidney fxn

Question 16

Give _____ to elderly, what can happen?

Answer 16

Propofol - increased DOA

Question 17

Effect of aging on renal blood flow + GFR

Answer 17

decline 1.5% per year

Question 18

Why are lipid drugs prolonged in elderly?

Answer 18

intracellular H2O decreases with age + increase 10% body fat

Question 19

Avoid _____ in Lewy Body Dementia

Answer 19

haldol

Question 20

Elderly have _____ volume of distribution

Answer 20

increased

Question 21

Opioids: reduce by ____

Answer 21

50%

Question 22

autonomic changes

Answer 22

dysautonomia of aging

Question 23

Elderly patients have a _____ threshold of _____

Answer 23

higher threshold of pain
(d/t decreased myelinated fibers)
*delayed recognition of painful conditions

Question 24

Fluid of choice with elderly

Answer 24

LR

kidneys not able to handle salt/water load

Question 25

high cardiac risk surgery

Answer 25

- aortic + major vascular (peripheral arterial) | - risk of cardiac death or nonfatal MI > 5%

Question 26

intermediate cardiac risk surgery

Answer 26

- carotid endartectomy, head/neck, intraperitoneal/intrathoracic, orthopedic, prostate surgery - risk of cardiac death or nonfatal MI 1-5%

Question 27

Low cardiac risk surgery

Answer 27

ambulatory, endoscopic, cataract, breast surgery | < 1% risk of cardiac death or nonfatal MI

Question 28

Risk of Alzheimers > 85 y/o

Answer 28

32%

Question 29

Dementia patients may be on

Answer 29

``` cholinesterase inhibitors (donepezil, rivatsigmine, galantamine) ```

Question 30

Risk of patients on cholinesterase inhibitor

Answer 30

reduce plasma cholinesterase - SCh prolonged DOA - anticholinergic (neostigmine) = unpredictable response

Question 31

NMBA preferred in elderly

Answer 31

cis/atracurium | *ester hydrolysis/hoffmann degradation

Question 32

Effect of scopolamine, diphenhydramie, meperidine on elderly

Answer 32

decrease in cholinergic receptor activity enhances side effects of these anticholinergic agents

Question 33

DOC - volatile anesthetic

Answer 33

desflurane | *low solubility, rapid emergence from anesthesia

Question 34

Monitor for _____ if giving Desflurane to elderly

Answer 34

Tachy | HTN

Question 35

MAC ______ with age

Answer 35

decreases linearly

Question 36

Dose of all IAs should ______ % per decade > 40 y/o

Answer 36

6% per decade over 40

Question 37

Postop: age is not associated with _____ complications

Answer 37

CVS | *every other system, age IS a risk

Question 38

Up to ____ % of patients who develop POD never return to preop state

Answer 38

40%

Question 39

Risk of stroke in elderly after anesthesia

Answer 39

< 0.5%

Question 40

ABCs of anesthetic plan for elderly patient

Answer 40

A: assess B: balance risk/benefit C: Compensate

Question 41

hospital readmission is higher in patients > ____ y/o

Answer 41

> 80 y/o

Question 42

Useful predictor for perioperative outcomes in older adult

Answer 42

frailty