Anesthesiology clinics
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Anesthesiology clinics · Sep 2009
Review Case ReportsInformed consent and the ethical management of the older patient.
Informed consent in elderly patients presents many ethical and legal challenges. Most aging patients are competent to provide consent for medical care. The purpose of informed consent is to promote autonomy, to protect a patient from undesired treatment, and to help the patient to make appropriate medical care decisions that correlate with his or her personal values. ⋯ Advance directives are legally and ethically binding tools by which patients can express their decisions regarding medical care before they lose capacity to do so. Discussion of do-not-resuscitate orders is part of informed consent, and patients' wishes regarding resuscitation in the operating room should be respected. Surrogate consent for participation in research is not necessarily allowed by IRB approval and research protocols.
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Postoperative urinary retention (PUR) is a common complication of surgery and anesthesia. The risk of retention is especially high after anorectal surgery, hernia repair, and orthopedic surgery and increases with advancing age. ⋯ Portable ultrasound provides rapid and accurate assessment of bladder volume and aids in the diagnosis and management of PUR. Catheterization is recommended when bladder volume exceeds 600 mL to prevent the negative sequelae of prolonged bladder overdistention.
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Anesthesiology clinics · Sep 2009
Review Case ReportsPerioperative use of beta-blockers in the elderly patient.
Elderly patients are increasingly referred for complex surgery, but are at particular risk for coronary artery disease. One strategy to prevent perioperative cardiac events in elderly patients is to employ perioperative beta-blockade, but doing so has the potential to increase the incidence of congestive heart failure, perioperative hypotension, bradycardia, and stroke. This article examines common comorbidities in the elderly who may benefit from the chronic use of beta-blockers, prophylactic perioperative use of beta-blockers including timing, dosage, and choice of beta-blocker, the pharmacologic effects of aging, and recommendations on the use of beta-blockers.
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Anesthesiology clinics · Sep 2009
Review Case ReportsPostoperative cognitive dysfunction in the elderly.
Despite improvement in surgical techniques, anesthetic management, and intensive care, a significant number of elderly patients develop postoperative cognitive decline. Postoperative cognitive dysfunction (POCD) is a postoperative memory or thinking impairment that has been corroborated by neuropsychological testing, for which increasing age is the leading risk factor. POCD is multifactorial in origin, but it remains unclear whether its occurrence is a result of surgery or general anesthesia. This article discusses the incidence, assessment, consequences, and prevention of POCD, as well as anesthetic strategies to improve cognitive outcome in elderly patients.
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Deep brain stimulation (DBS) has added to the comfort and quality of life for an increasing number of Parkinson's disease (PD) patients. The anesthesiologist needs to understand the pathophysiology of the disease, the surgical procedure, and its postoperative implications to most effectively manage these patients. ⋯ In terms of the general anesthetic management of PD patients, it is clear that no simple anesthetic regimen exists. Anesthesiologists can provide the best care through preoperative assessment, maintenance of PD drug therapy, and avoidance of known precipitating agents.