Current opinion in anaesthesiology
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Both surgical workload and the age of those patients being considered for radial pulmonary resection are increasing. Enhanced recovery programmes are now well established in most surgical disciplines and are increasingly reported in thoracic procedures. This review will discuss the relevant principles of these programmes as applied to an increasing elderly population. ⋯ Elderly patients are suitable for enhanced recovery programmes but these must be tailored to individual circumstance. Further work is required to comprehensively assess their value in a modern healthcare setting.
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As the population ages, the increase in chronic illnesses among patients with decreasing lung function will pose a major public health challenge. Determining which elderly patients are fit for surgery is an increasingly important skill. Anesthetic care of elderly patients requires an understanding of the effects that chronic diseases have on normal age-related changes in physiology and function. Postoperative respiratory complications are significantly increased in patients over 65 years of age, especially those with preexisting diseases. ⋯ Aging can increase the risk of postoperative complications because of a loss of physiologic reserve and airway defenses. These limitations may only become apparent after the stressors of surgery and anesthesia.
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Curr Opin Anaesthesiol · Feb 2018
ReviewAn update on preoperative assessment and preparation of surgical patients with obstructive sleep apnea.
There is a high prevalence of obstructive sleep apnea (OSA) in the surgical population, however, a significant proportion of patients are undiagnosed. The Society of Anesthesia and Sleep Medicine (SASM) has issued recent guidelines for preoperative assessment and preparation of patients with known or suspected OSA. The purpose of this review is to highlight key points in the new guidelines and explore the possibilities of different strategies in optimizing patients with OSA preoperatively. ⋯ The prevalence of OSA in surgical patients is high. SASM has made recommendations in their published guidelines for the optimum preoperative preparation of patients with OSA. In the future, research may shift towards finding the underlying mechanism of OSA for targeted therapy.
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Elderly patients presenting with thoracic malignancies tend to be largely undertreated because of a presumption that this group will incur a high treatment-associated morbidity and mortality. The current review highlights the current practice and recent updates in the surgical management of thoracic malignancies, mainly lung cancer, in the elderly population. ⋯ There is growing evidence from the literature that surgical resection is relatively safe in the elderly population. Age by itself should not preclude patients from having curative resection. Resections can be tailored to performance status of the patient.
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Curr Opin Anaesthesiol · Feb 2018
ReviewAn overview of perioperative considerations in elderly patients for thoracic surgery: demographics, risk/benefit, and resource planning.
Increasing numbers of geriatric patients will present for thoracic surgery as the population ages. The changes in physiologic reserve as well as the increase in comorbid conditions among this population must be considered in order to optimize patient care in the perioperative period. ⋯ Elderly patients with early-stage lung cancer derive benefit from surgical treatment, despite their increased prevalence of comorbidities, because survival associated with untreated lung cancer is so dismal. Some studies suggest that even late-stage lung cancer patients may benefit from surgery as part of a multimodal approach. Further studies could help target implementation of resources to optimize overall patient health and physiologic condition in order to decrease morbidity and mortality and to optimize quality of life.