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APA 2 > Geriatric Anesthesia > Flashcards

Geriatric Anesthesia Flashcards

(92 cards)

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1
Q

**Cardiovascular changes in the elderly - _________ in elasticity of arteries

A

decreased

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2
Q

**Cardiovascular changes in the elderly - _______ afterload

A

elevated

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3
Q

**Cardiovascular changes in the elderly - ________ systolic pressures

A

elevated

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4
Q

**Cardiovascular changes in the elderly - Left ventricular ___________

A

hypertrophy

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5
Q

**Cardiovascular changes in the elderly - Adrenergic activity _________

A

decreases

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6
Q

**Cardiovascular changes in the elderly - ________ heart rate (both resting and max)

A

decreased

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7
Q

**Cardiovascular changes in the elderly - _________ baroreceptor response

A

decreased

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8
Q

**Cardiovascular history to be concerned about

A

AS, History of arrhythmias, CHF, HTN, CAD

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9
Q

Heart rate declines 2 beat per minute per year over the age ____

A

50

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10
Q

Conduction system _______ and loss of SA node cells increases chance of _________

A

fibroses / arrhythmias

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11
Q

Atrial enlargement puts them at risk for what?

A

SVT and Afib

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12
Q

Left ventricular wall thickens by decreasing the ________

A

cavity

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13
Q

What does this describe? Ventricular DILATION while maintaining normal sarcomere lengths - the heart can expand to receive a greater volume of blod. The wall thickness normally increases in proportion to the increase in chamber radius. This type of hypertrophy is termed _________ hypertrophy

A

eccentric

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14
Q

In the case of CHRONIC pressure overload (as through anaerobic exercise, which increases resistance to blood flow by compressing arteries), the chamber radius MAY NOT change; however, the wall thickness greatly increases as new sarcomeres are added in-parallel to existing sarcomeres. This is termed _______ hypertrophy

A

Concentric

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15
Q

Decrease in their cardiovascular system causes drop in BP during ________. Autonomic responses that maintain homeostasis progressively decline. This is termed _____ ____

A

induction / autonomic dysfunction

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16
Q

**Circulation time will slow ___ drugs but speeds up induction with _______ agents

A

IV / inhalation

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17
Q

The elderly patient is more dependent on an increase in _______ than increase in ______ to produce an increase in CO. These factors make the geriatric patient more prone to _____ when large volumes of IVF are administered in the presence of anesthetic induced myocardial depression and hypotension. So this makes a good case to give _______ instead of crystalloids.

A

EDV / HR / CHF / colloids

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18
Q

**Respiratory changes in the elderly - ________ in elasticity of lungs

A

decrease

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19
Q

**Respiratory changes in the elderly - _______ in alveolar surface area

A

decrease

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20
Q

**Respiratory changes in the elderly - __________ residual volume

A

increased

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21
Q

**Respiratory changes in the elderly - ________ mismatch

A

V/Q

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22
Q

**Respiratory changes in the elderly - _________ chest wall ridgity

A

increased

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23
Q

**Respiratory changes in the elderly - ________ cough

A

decreased

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24
Q

**Respiratory changes in the elderly - Blunted response to _______ and ______

A

hypercapnia and hypoxia

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25
**Respiratory changes in the elderly - ________ max breathing capacity
decreased
26
**Respiratory changes in the elderly - ________ closing capacity and closing volume
increased
27
Common History and Physical items related to geriatrics and respiratory
Lung CA, Pneumonia, emphysema, chronic bronchitis
28
See an overall ______ of alveoli and _______ of small airways
distention / collapse
29
Arthritis in mouth opening and cervical spine may cause what?
difficult intubagtion and small mouth opening
30
The elderely have a increased risk of aspiration r/t to decrease in ______ reflexes
airway
31
With the elderly, FRC _______ slightly
increases
32
Vital capacity significantly decreases 25 ml/year starting at age ____
20
33
Residual volume _______ with age
increases
34
Total lung capacity ________ with age
decreases
35
Elderly have signs of both ______ and ________ disease
restrictive and obstructive
36
Dead space ______ in elderly
increases
37
**Does Vd/Vt ratio increase or decrease with age
increase
38
Gastric changes in the elderly
gastric pH rises, gastric emptying slows, some elderly have smaller stomach volumes than younger patients
39
Heat production ______ with age and heat loss________
decreases / increases
40
**Three things that put elderly at risk for heat loss
dereased metabolic rate, decreased heat production, deficient thermostat control
41
If it's a belly surgery, make sure you have what on the OR table
K-pad warmer
42
**What renal IMPAIRMENTS are noted with the elderly?
impaired sodium handling, impaired fluid handling, impaired potassium excretion
43
**What is renal decreases do we see with elderly?
decreased blood flow, GFR, renal mass, concentration, dilution, drug excretion, renin-aldosterone response
44
What might you expect renal wise on the elderly history and physical?
prostatic obstruction, CHF, hypertensive nephropathy, diabetic nephropathy
45
Renal cortex is replaced with ____ and _____ tissue
fat and fibrotic
46
Serum creatinine is the _____ r/t decrease in muscle mass and decreased production of creatinine
same
47
BUN gradually INCREASES ____% mg/dl per year
0.2% mg/dl
48
They are predisposed to _______ as well as _____ ________ r/t sodium, diluting, and conentration management changes
dehydration / fluid overload
49
Inability to _______ glucose
reabsorb
50
Decreased blood flow to kidneys in this population increases their risk of ____ ____ ___
acute renal failure
51
They are predisposed to ______ and __________ with the prescription of diuretics
hyperkalemia and hypokalemia
52
**What is the most specific test or renal failure
serum creatinine clearance
53
Cerebral blood flow and brain mass _____ with age
decrease
54
Neurotransmitters (dopamine) __________ and their receptors ______ as well
decrease / decrease
55
Physical activity shows to preserve _____ function
cognitive
56
Degeneration of peripheral nerves slows conduction and reactions which leads to muscle _______
atrophy
57
There is ________ in thresholds to touch, temp and pain
increase
58
Threshold ______ in proprioception, hearing and vision
increases
59
Dosages for locals and general anesthetics are ______ in the elderly
reduced
60
Epidural anesthetic tends to have a more _______ spread
cephalad
61
Epidural anesthetic has a shorter duration on _____ and ______
analgesia and motor
62
Geriatrics need more time to recover _______ from GA. Consider this when outpatient surgery is being done - do they have care system in place?
cognitively
63
In geriatrics there is a ______ incidence of confusion, delerium and cognitive disruptions
higher
64
What can confusion and delerium in geriatrics be related to?
drug effects, pain, previous dementia, hypoxemia, and metabolic disturbances
65
**T/F Geriatrics are VERY sensitive to anticholinergics like scopolamine and atropine
TRUE
66
Some suffer prolonged or even permanent cognitive problems but believed to be _____ _________ related
non anesthetic
67
Skin _______ with age, and is prone to tearing. Veins are frail and hard to _________. Arthritic joints make _______ difficult
atrophies / cannulate / postioning
68
Pharmacokinetic
relationship between drug dose and plasma concentrations
69
Pharmacodynamic
relationship between plasma concentrations and clinical effect
70
_________ in muscle mass and _______ in body fat
decrease / increase
71
Total body water ________ which effects water soluble drugs
decreases
72
Reduced volume for water soluble drugs can lead to higher _______ concentrations
plasma
73
Conversely, fat soluble drugs with increased volume of distribution can lower _____ concentrations
plasma
74
Many drugs have PROLONGED effects r/t ______ and ______ function declining
renal and hepatic
75
MAC for inhalation agents decrease ___ % decade after age ____
4% / 40
76
Onset of inhalation agents is more rapid if CO is ______
decreased
77
Myocardial depressants effect exaggerated while the TACHY response is _______
decreased
78
Reasons for longer wake up?
increased body fat, decreased hepatic and decreased pulmonary gas exchange
79
Lower doeses needed for what drugs?
benzos, barbs, opiod agonists
80
There is no change in muscle relaxant effectgs but there can be a ________ excretion due to decreased ________ function
prolonged / renal
81
**Which plasma protein is increased in the elderly. It also binds with local anesthetics and opiods.
alpha-1 glycoprotein
82
Progeria
Called Hutchinson-Gilford syndrome (premature aging)
83
Progeria is apparent after ____ months of age
6 months
84
Progeria patients will have signs of what?
heart disease, HTN, cerebrovascular disease, osteoarthritis, DM
85
Airway considerations with Progeria
mandibular hypoplasia (underdevelopment), Micrognathis (micromandible), Narrow glottic opening
86
Average life span for someone with progeria?
13 years
87
Choose drugs wisely. Elderly patients have variable if not decreased requirements. Think REGIONAL, but always be prepared to administer ________ if unable to perform regional or if regional fails
general
88
JUST FYI
give beta-blockers, ABX, AVOID hypothermia
89
Be prepared for greater hemodynamic ________ inta-op and postop
instability
90
Plan post op analgesia ________
carefully
91
Monitor for sub-clinical events. Signs and symptoms of untoward events are often ______ in the elderly
nonspecific
92
Allow the elderly more time to repsonse to questions, requests, drugs, and time to ______ from anesthesia/achieve extubation criteria
emerge

APA 2 (7 decks)

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