Clinics in geriatric medicine
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Clin. Geriatr. Med. · May 2014
ReviewManagement of postoperative complications: cardiovascular disease and volume management.
Postoperative cardiovascular complications are common, predictable, and typically treatable in geriatric patients who have sustained fractures. Although intervention-specific data are sparse, observational evidence from high-performing geriatric fracture centers coupled with an understanding of geriatric principles can serve as a basis for treatment guidelines. Many patients can be safely and effectively managed with close attention to intravascular volume status, heart rate control, and minimization of other physiologic stresses, including pain and delirium. Many chronic cardiovascular therapies may be harmful in the immediate postoperative period, and can usually be safely omitted or attenuated until hemodynamic stability and mobility have been restored.
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Clin. Geriatr. Med. · May 2014
ReviewSpecial anesthetic consideration for the patient with a fragility fracture.
In this article, an overview is presented of perioperative management of the patient with a fragility fracture, including preoperative risk stratification and optimization, anesthesia risks, anesthesia options, and postoperative pain management. Issues of preoperative evaluation that are of concern for the anesthesiologist because of their direct effect on intraoperative care are discussed. A team interdisciplinary approach and good communication between specialties involved in care of elderly surgical patients is important for optimal patient outcomes and to avoid perioperative complications. Cooperation between anesthesiology and medicine is indispensable in reaching a reasonable consensus regarding preoperative evaluation and should occur on a case-by-case basis.
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Delirium is a common postoperative surgical complication associated with poor outcomes. The complexity of delirium demands that each patient be assessed individually and a tailored prevention and treatment regimen be put in place. Nonpharmacologic and pharmacologic strategies are available to achieve this goal.
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Because most older adults with hip fractures require urgent surgical intervention, the preoperative medical evaluation focuses on the exclusion of the small number of contraindications to surgery, and rapid optimization of patients for operative repair. Although many geriatric fracture patients have significant chronic medical comorbidities, most patients can be safely stabilized for surgery with medical and orthopedic comanagement by anticipating a small number of common physiologic responses and perioperative complications. In addition to estimating perioperative risk, the team should focus on intravascular volume restoration, pain control, and avoidance of perioperative hypotension.
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Clin. Geriatr. Med. · May 2014
ReviewPreoperative management of anticoagulation and antiplatelet agents.
This article describes current literature and treatment plans for managing anticoagulation and antiplatelet agents in patients presenting with hip fractures. Indications for anticoagulation and antiplatelet agents are discussed, and management techniques for when patients present with hip fractures are reviewed.