"Hey Gerry..."
This term describes the reduced ability of elderly patients to tolerate physiological stress due to diminished organ reserve.
What is frailty?
The MAC for inhalational anesthetics decreases by this percentage per decade after age 40.
What is 6-7% per decade?
This results in reduced Phase 1 drug metabolism.
What is reduced hepatic blood flow?
This postoperative phenomenon is often linked to the use of benzodiazepines in elderly patients, especially those over the age of 80.
What is postoperative delirium (POD) or postoperative cognitive dysfunction (POCD)?
Permanent pacemakers and implanted cardiac defibrillators are examples.
What are cardiac implantable electronic devices (CIEDs)?
These two cognitive complications are concerns in elderly patients following surgery and anesthesia.
What are postoperative delirium (POD) and postoperative cognitive dysfunction (POCD)?
These two commonly used neuromuscular blocking agents undergo Hofmann elimination and are not affected by renal or hepatic function.
What are cisatracurium and atracurium?
This cardiovascular change in the elderly leads to increased systolic blood pressure and left ventricular hypertrophy.
What is reduced arterial compliance?
This alteration in body composition prolongs the effect of lipid-soluble anesthetic agents in the elderly.
What is an increased body fat percentage?
This type of cautery is preferred with CIEDs.
What is bipolar cautery?
Due to a higher risk of intraoperative hypotension, exaggerated responses, and/or postoperative delirium, this technique may be preferred over general anesthesia for some elderly patients.
What is regional anesthesia?
This organ undergoes atrophy with aging, resulting in decreased plasma cholinesterase activity and prolonged metabolism of ester anesthetics.
What is the liver?
This physiological decline in renal function leads to the prolonged elimination of renally excreted drugs.
What is decreased glomerular filtration rate (GFR)?
This airway management concern in the elderly results from loss of muscle tone and increased airway collapsibility.
What is airway obstruction or early desaturation?
Name two devices you want to have with you and/or near you when anesthetizing a patient with a CIED?
What are magnet and external pacing or defibrillator device?
This phenomenon, common in elderly patients, has a very noticeable impact on the induction of general anesthesia. (Think low and slow.)
What is increased arm-brain circulation time?
Preoperative evaluation of these two organ systems is crucial due to their significant impact on anesthesia outcomes in elderly patients.
What are the cardiovascular and pulmonary systems?
Hypothermia occurs more readily in elderly patients due to this decline in physiologic function.
What is decreased thermoregulation?
This pulmonary volume change results from decreased lung elasticity.
What is increased residual volume?
Unintended reprogramming or cardiac defibrillation can occur.
What are unintended consequences from the use of the electrosurgical unit?
Decreased metabolism and elimination of anesthetic drugs can result in this prolonged effect in elderly patients. (NOT POD or POCD.)
What is delayed emergence?
Elderly patients rely more on this phase of cardiac function to maintain adequate stroke volume.
What is atrial contraction (or diastolic function)?
This reduction, commonly associated with elderly patients, is associated with increased sensitivity to intravenous anesthetics.
What is reduced total body water or volume of distribution?
This results from decreased blood flow to the subarachnoid space and a smaller volume of CSF.
What is a 'longer duration of' or 'altered response to' a spinal anesthetic?
Name five pieces of information or data an anesthesia provider should know when caring for patients with CIEDs.
What are: the date of the last interrogation, type of device, manufacturer & model, battery life, lead life, indication, mode, etc.?