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Anesthesia Principles > Geriatrics > Flashcards

Geriatrics Flashcards

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1
Q

Frailty reflects a decrease in ____ and an inability to respond to physiological challenges presented by the stress of surgery.

A

FRC

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2
Q

Frailty signs include?

A 
weight loss
fatigue
imparied grip
low physical activity
slow gait
cognitive decline (sometimes)
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3
Q

Frailty is an independent predictor of

A

in-hospital mortality

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4
Q

With aging, there is an overall reduction in neuronal _____ capacity

A

regenerative

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5
Q

In elderly how doe sthe mass of the brain change?

A

decreases by @15%

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6
Q

Why does the mass of the brain decrease with age?

A

D/t cell loss and shrinkage of cell volume

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7
Q

Neural connections play a critical role in brain function are are responsible for the ___ of the brain.

A

neural plasticity

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8
Q

W/ aging, neural plasticity _____ and neuronal connectivity may ______.

A

decrease; increase

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9
Q

In the elderly there is an impairment of what NT signal transduction pathways?

A

dopamine

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10
Q

Why is the impairement of dopamine signal transduction pathways important to note int he elderly?

A

may explain the susceptibility of elderly to extrapyramidal s/e of dopamine receptor antagonists

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11
Q

in the eldelry, cv changes include decreased ____ and ____ compliance

A

vascular and myocardial

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12
Q

In the elderly there is a decrease in what?

A

autonomic responsiveness

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13
Q

Functional capacity of ____ METS is associated w/ potential adverse outcomes.

A

<4

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14
Q

4 METS equals what?

A

can walk to mailbox and back

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15
Q

10 mets equals what?

A

running on treadmill 1minutes

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16
Q

1 met equals what?

A

lying in bed

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17
Q

Why is there a decline in HR in the elderly?

A

increased vagal tone and decreased sensitivity to adrenergic receptors

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18
Q

Maximal HR declines by @ ____ per year over the age of 50.

A

1 beat/min

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19
Q

Eldelry patients undergoing echo evaluation have an increased incidence of _____ dysfunction.

A

diastolic

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20
Q

Why do eldelry patients may poorly tolerate perioperative fluid administration?

A

D/t distolic dysfunction

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21
Q

Fluids in elderly patients w/ poor diastolic function may result in ?

A

elevated LVEDP and pulmonary congestion

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22
Q

Why do elderly patients have an exaggerated decrease in BP with induction?

A

diminished cardiac reserve

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23
Q

In elderly patients, a ____ cirrculation time ___ the onset of IV drugs and ___ the onset of inhalation drugs.

A

prolonged
delays
speeds

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24
Q

What 3 physiologic changes of the respiratory system occur in the elderly?

A

mechanical
gas exchange
sensing mechanism

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25
In eldelry, what elastic changes occur, if any?
decrease in elasticity
26
What happens to the chest wall in elderly patients?
becomes stiffer as lung tissue loses its intrinsic elastic recoil
27
Respiratory muscle mass remains the same but reserve ability decreases in eldelry patients. T/F
F - muscle mass is also decreasaed
28
What should be done to prevent periop hypoxia in the elderly?
longer preoxygenation increased inspired O2 concentrations PEEP pulmonary toliet
29
What factors increase risk of postop pulmonary complications?
``` older age COPD OSA malnutrition abdominal or thoracic surgery ```
30
___ and ___ O2 consumption decline with age
basal and maximal
31
When does peak weight normally occur?
60 years
32
What metabolic changes occur in elderly patients that would affect temperature?
heat production decreases heat loss increases hypothalamic centers reset at lower level
33
What regulates temperature?
hypothalamus
34
Why are hormone productions reduced in the elderly?
endocrine gland atrophy
35
Deficiences of what metabolic hormones are often present in the elderly?
``` insulin thyroxine growth hormone renin aldosterone testosterone ```
36
Diabetes affects @___% of patients older than 70
15
37
Aging is associated with a decreased response to what agents?
Beta adrenergic
38
What happens to the kidneys with age?
blood flow and mass is decreased
39
The decreased capacity to handle water and electrolyte loads makes proper fluid management more critical; elderly patients are more predisposed to developing ____ and _____. 
hypokalemia | hyperkalemia
40
The motility of the ____ area is altered with aging.
oropharyngeal/upper esophageal area colon Gi drug metabolism
41
THe rate of biotransformation and ____ production decreases in the elderly patient.
albumin
42
What levels are reduced in elderly men?
plasma cholinesterase
43
A BMI of ___ indicates poor nutrtion
<18.5
44
A albumin ____ indicates poor nutrition
<3
45
Malnutrition is indicated by an unintended weight loss of ____ within 6 months.
10%
46
What happens to the brain size with age?
mass decreases
47
Where is neuronal loss prominent in elderly?
cerebral cortex, esp. frontal lobes
48
CBF ____ in edlery
decreases 10-20%
49
The syntehesis of ____ is reduced in the elderly
NT
50
What binding sites are reduced in the eldelry patient?
serotonergic adrenergic GABA
51
Does MAC increase, decrease, or stay the same in the elderly?
decrease
52
Administration of given volume of epidural LA tends to result in ____ in the elderly
mroe extensive spread
53
What is an early hallmark of dementia?
intellectual decline
54
What is an anesthesia concern in patients with dementia?
ability to provide informed consent
55
What are risk factors for falls in the elderly?
poor muscle strength neural damage in the basal ganglia and cerebellum peripheral neuropathy
56
Polypharmacy is the norm for the eldelry. T/F
true
57
What kind of pharmacologic changes occur in the elderly?
Pharmacokinetic | Pharmacodynamic
58
Why are eldelry aptients more sensitive to anesthetics?
loss of neuronal tissue or poorly defined changes in receptor function
59
In elderly patients, TBW decreases by what amount >
10-15%
60
In elderly patients, with a decreased TBW, rapid IV admin of an anesthetic dug will ______ the ____ plasma concentration
increase; initial
61
____ increases as muscle mass decreases in eldelry pateints
body fat
62
Lipid soluble drugs have a large ____ in elderly patients
Volume of distribution
63
Drugs metabolized by P450 may have reduced clearance of about ____ in eldelry pateints.
30-40%
64
MAC increases, decreases, or stays the same with incrased age?
decreases
65
MAC values decreases by about _____ per ____ after the age of 40 for volatiles.
4-6% | decade
66
Dosage adjustment of Propofol for elderly pateints?
50% decrease
67
Is etomidate an analgesis?
no
68
Is etomidate an amnestic?
yes
69
Etomidate has a smaller initial ___ than Propofol or thiopental
Vd
70
There is not an increase in sensitvity to Etomidate in elderly pateints. T/F
False - there is, lower induction doses are recommended
71
What is a common concern post-op with Etomidate?
vomiting | VOMITDATE
72
The central Vd of Thipental ___ in the elderly?
decreases
73
What is the suggested dose decrease for Thiopental in elderly?
50-80%
74
What is Midazolam metabolized to?
hydroxymidazolam
75
Is the metabolite of Midazolam active or inactive?
active
76
How is Midazolam excreted?
kidneys
77
What would cause an accumulation of Midazolam?
diminished renal function
78
Are elderly patients sensitive to Midazolma?
yes
79
What happens to opioid receptor system with aging?
receptor density receptor affinity receptor binding may all change
80
What affects the choice of opioids to use in the elderly?
pharmacokinetics
81
Are the pharmacodynamics of NMBD altered with age?
no
82
Are the pharmacokinetics of NMBD altered with age?
yes
83
In elderly patients, recovery from NMBD is increased by as much as what?
50%
84
The impact of residual NMBD block on ____ function can be very significant in the elderly.
pharyngeal function
85
Age is an indication for invasive monitoring. T/F
false
86
Over-hydration can lead to what?
CHF
87
Fluid resuscitation and blood component therapy should be used ___ in eldelry.
judiciously
88
____ Hgb and Hct may be more desirable in the elderly.
higher
89
what type of dysfunction is very common in the elderly after surgery?
neurocognitive
90
Hospitalized patients with delirium have up to a ___ x higher risk of developing other medical complications.
10
91
What is the strongest predisposing factor for postop delrium?
preexisting dementia

Anesthesia Principles (10 decks)

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