Best practice & research. Clinical anaesthesiology
-
The orthopaedic surgeon brings to the operating room some of the greatest challenges for the anaesthesiologist. Various factors, such as age, health status, disease process, type and extent of operative procedure, provide differing circumstances, which an anaesthesiologist is obliged to cope with. This contrasts to other surgical specialities in which patient factors and operative procedures are much more predictable. ⋯ The concept of the optimal post-operative multimodal regimen needs to be defined. The application of NSAID and paracetamol is an integral part of this concept, and the dose of opioids should be titrated to the lowest efficient dose needed. Thus, this chapter discusses the different controversies and future trends of anaesthesia with regard to the elderly in orthopaedic surgery.
-
Demographic data indicate an increasing workload of geriatric anaesthesia due to advancing life expectancy and reduced thresholds for high-invasive and high-risk surgery in the elderly. Chronological and biological age may be inconsistent, and the existence of age-related changes may vary between organ systems in the same individual. ⋯ In conclusion, listing current diagnoses will not be sufficient in the assessment of the geriatric patient because age-related changes do not necessarily manifest as pathological entities. Rather, pre-operative examination should focus on determination of individual margins of organ function reserve.
-
The elderly are an expanding population of patients presenting for anaesthesia. The pharmacokinetics of anaesthetic agents in the elderly deserves special attention because the normal ageing process and the effect of age-related diseases affect organ systems in a heterogeneous way with unpredictable consequences. The pharmacokinetics of each drug is also affected by these changes in a specific way and, together with the pharmacodynamic consequences, makes drug use and drug dosing challenging in this population. Although a decrease in bolus and infusion rates is a common theme, only pharmacokinetic modelling of drug disposition in the elderly will provide accurate dosing guidelines and increase the margin of safety.
-
Best Pract Res Clin Anaesthesiol · Jun 2003
ReviewCo-medications, pre-medication and common diseases in the elderly.
Typically, old patients scheduled to undergo a surgical procedure take many medications for various disorders. The anaesthetist must consider the benefits and/or risks of continuation or withdrawal of such chronic medications. This chapter reviews these issues in respect of cardiovascular drugs (calcium channel blockers, beta adrenoreceptor antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists) and of psychotropic and antiparkinson medications and insulin. Focus is put on the few scientific studies available and on the recommendations given by experts in the field.
-
The number of aged individuals is growing, and consequently the demands on resources for cardiac surgery will increase in the elderly. Even in the absence of obvious coexisting diseases, advanced age is always accompanied by a general decline in organ functions, and specifically by changes in structure and function of the heart and vasculature that will ultimately affect cardiovascular performance (e.g. hypertension, ischaemic heart disease, etc.). These alterations have to be taken into account when older patients require anaesthesia for cardiac surgery. ⋯ Essential monitoring should include pulmonary artery catheterization and/or transoesophageal echocardiography. During cardiac surgery the risk for elderly individuals is increased; in particular, the central nervous system is more often compromised in the elderly than in younger patients. However, elderly patients without significant co-morbidity have a mortality rate comparable to that of younger patients.