Geriatric Anesthesia Flashcards
(41 cards)
1
Q
Physiologic Changes
A
2
Q
Mechanisms of Aging
A
3
Q
Hemodynamic Stability
A
- The change in sympathetic nervous system activity that accompanies a change in blood pressure is actually enhanced with age.
- Despite the likelihood that the alpha-receptor response to stimulation may decrease slightly with age, the vasoactive component of the baroreflex in the elderly is as effective as in young adults, if not more so.
4
Q
Cardiovascular System
A
5
Q
Heart Rate and Cardiac Reserve
A
6
Q
Oxygen Carrying Capacity
A
7
Q
Exercise Tolerance
A
8
Q
Contractility
A
9
Q
Systolic Hypertension
A
11
Q
This figures illustrates the composition of the arterial pressure waveform from a combination of a forward pressure wave created by ventricular contraction and a reflected wave.
A
12
Q
Venous Stiffening
A
13
Q
Autonomic Function
A
14
Q
Decreased Response to Atropine
A
15
Q
Ventilatory System
A
16
Q
Central Nervous System
A
17
Q
Body Composition
A
18
Q
Renal Function
A
19
Q
Hepatic Function
A
20
Q
Basal Metabolic Rate
A
21
Q
Airway Reflexes
A
22
Q
Airway Management
A
23
Q
Anesthetic Requirements
A
24
Q
Regional vs. General
A
25
Regional
26
SAB/ Epidural
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Labile BP with SAB/Epidural
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Question
29
Choice of Agents
30
Propofol
31
Opioids
32
Ketamine
33
Perioperative Risk and Outcome
34
Management of Hypotension
1. Fine line between too much and too little volume
2. Try to resuscitate volume prior to surgery, clear liquids permitted up to 2 hours before surgery
3. Usual volume replacement can lead to excessive fluid once anesthetic is done, sympathetic activity decreases. "Run the patient dry"
4. Use endpoints such as urine output, decreased central venous pressure, or pulmonary wedge pressure, echo, etc.
5. Age is rarely indication for central venous or pulmonary artery, indicated by procedure
6. If low SVR, a-agonist (phenylephrine) is best choice, plus volume administration is best
7. Low dose dopamine or epinephrine may work better
35
Dementia and General Anesthesia
36
Dementia and General Anesthesia
[http://medicalxpress.com/news/2012-09-surgery-profound-effect-anesthesia-brain.html](http://medicalxpress.com/news/2012-09-surgery-profound-effect-anesthesia-brain.html)
37
Post-operative Cognitive Decline
[http://medicalxpress.com/news/2012-09-surgery-profound-effect-anesthesia-brain.html#jCp](http://medicalxpress.com/news/2012-09-surgery-profound-effect-anesthesia-brain.html#jCp)
38
What's the cause of dementia?
[http://www.scientificamerican.com/article/can-general-anesthesia-trigger-dementia/](http://www.scientificamerican.com/article/can-general-anesthesia-trigger-dementia/)
39
Marcantonio (2001)
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Ofirmev
41
Conclusion
