Anesthesia Considerations 

Geriatric Patient

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Considerations​

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• ↑ post-op morbidity and mortality

• Screen for dementia → try prevent post-op delirium & POCD with:

  • ​↓ anesthetic doses

  • employ BIS/EEG monitoring to titrate minimum anesthetic

• MSK Δ's with aging predispose to ↑ risk of nerve, joint & skin injury

• Pre-operative frailty assessment tool can risk stratify patients much better than just using "age"

• Multiple co-morbid conditions + potential for polypharmacy

• Pharmacologic considerations:

  • ↓ dose requirements for IV anesthesics

  • ↑ sensitivity to opioids

  • ↑ duration of neuromuscular blockers except cis-atracurium

  • Avoid ketamine to avoid risk of post-op delirium

  • Undesirable side-effects from diphenhydramine, anti-cholinergics, benzos, metoclopramide, NSAIDs, meperidine

• Consider neuraxial anesthesia > GA to:

  • ↓ risk of post-op delirium & POCD

  • ↓ post-op pulmonary complications

• Decreased physiologic reserve and Δ's in all organ systems

  • CVS

    • ↓ tachycardic response to hypotension → CO is preload dependent

    • ↓ baroreceptor sensitivity → limited response to hypovolemia & ↓ contractility

    • Rigid arteries → wider pulse pressure + labile blood pressures

    • Increasing prevalence of:

      • LV hypertrophy

      • CAD

      • Aortic valve disease

      • Arrhythmias esp. afib

  • Resp

    • ↑ WOB with age

    • Emphysematous-like changes → VQ mismatching

    • ↓ FRC, ↑CC → ↑shunting

    • PFTs: ↓FEV1, ↓DLCO, ↑A-a gradient

    • Weaker pharyngeal muscles and ↓ effective cough → ↑aspiration risk

  • CNS

    • ↓ MAC requirements

    • ↓ requirements of all IV anesthetics

    • ↑ duration of action of most medications

    • Avoid: diphenhydramine, anti-cholinergics, benzos, metoclopramide, NSAIDs, meperidine

    • ↑ prevalence of dementia

    • ↑ risk of post-op delirium and POCD

  • Renal

    • eGFR ↓ with age

    • ↑ prevalence of: HTN, DM, vascular dz → ↓ renal dysfunction

  • Endo

    • Malnutrition is common & ↑ morbidity & mortality

    • Impaired thermoregulation → ↑risk of hypothermia

    • ↑ prevalence of T2DM

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References​

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• Staheli B, Rondeau B. Anesthetic Considerations In The Geriatric Population. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572137/