Pharmacology
A reason why propofol induction doses should be decreased in the geriatric population.
What is:
1. Decreased metabolic clearance
2. Increased volume of distribution of adipose tissue
3. Decreased intravascular volume
Need 1 for correct response
Age-related pulmonary changes increase the risk of atelectasis because closing capacity exceeds which lung volume
What is functional residual capacity (FRC)?
This person should be used for consent to surgery if the patient does not have capacity
What is a substitute decision maker (SDM)?
Ephedrine Can be ineffective in the elderly for this reason
What is downregulation of beta-receptors and as well may be on beta-blockers, resulting in a lack of response to ephedrine.
Definition of postoperative delirium and when it most commonly presents
What is an acute, fluctuating disturbance of attention and awareness, typically developing within 48 hours postoperatively.
This time is often increased during induction due to decreased cardiac output and other age-related cardiovascular changes.
What is arm-brain circulation?
Lab value that is most appropriate to measure renal function in the elderly
What is GFR?
Three anatomical airway changes that occur as we age
What is:
1. Decreased C-spine ROM
2. Atrophy of facial soft tissue/muscle
3. Edentulous
4. Less effective cough
5. Loss of upper airway tone
Need 3/5 to obtain points
The vast majority of anesthetic drugs require dose reductions in the elderly except for which class (and why?)
What is NMBD: while the metabolism and elimination is decreased in the elderly leading to prolonged effects, the same dose is required to attain intubating conditions.
The non-pharmacologic strategies that have the strongest evidence for preventing postoperative delirium in elderly surgical patients
What are interventions such as early mobilisation, reorientation, sleep hygiene, cognitive stimulation, correction of visual or hearing impairment, nutrition and fluid repletion, adequate oxygenation.
Compared with younger adults, MAC requirements in the elderly change by approximately this much per decade.
What is decrease by ~6–7% per decade
After the age of 40, the volume and weight of the brain decrease by this much every decade.
What is 5%?
Polypharmacy is common in the elderly; name one tool recommended to identify potentially inappropriate medications
What is Beers criteria or STOPP/START criteria?
According to current evidence, are outcomes improved with general or regional anesthesia?
What is neither? Studies are conflicting and there are many cofounders.
The anesthetic technique that can reduce the risk for postoperative delirium.
What is avoiding excessively deep anesthesia?
This opioid is least affected by age-related renal or hepatic dysfunction due to its metabolism
What is remifentanil?
Elderly patients at higher risk of perioperative hypothermia based on what body composition changes?
What is reduced subcutaneous fat and muscle mass? (impairment of heat generation and insulation)
A simple bedside screening tool that is recommended when cognitive impairment is suspected preoperatively
What is the mini-cog assessment?
Elderly patients are particularly susceptible to hypothermia intraoperatively for this reason
What is increased sensitivity to hypothermia due to impaired thermoregulation and lower metabolic rate, increasing risks such as coagulopathy and prolonged drug effects.
Elderly patients are at increased risk of postoperative respiratory complications despite apparently adequate oxygenation in the PACU for this reason.
What is attenuated ventilatory responses to hypoxaemia and hypercarbia with impaired airway protective reflexes.
The recommended change in dosing for muscle relaxants (increase, decrease, no change)
What is no change?
Elderly patients often more dependent on preload but at higher risk of pulmonary edema with fluid loading due to what cardiac change
What is diastolic dysfunction with reduced ventricular compliance?
Aging leads to reduced physiologic reserve across multiple organ systems; this concept predicts outcomes better than chronological age.
What is frailty/clinical frailty score?
What is morphine? Due to the body composition changes of decreased total body water and increased body fat. Morphine is hydrophilic so it will have a reduced volume of distribution but it does not cross the BBB as readily.
In 2018, the nomenclature of "Postoperative Cognitive Dysfunction (POCD)" was updated to this.
What is Perioperative Neurocognitive Disorders?