Term
| is advance age a contraindication for anesthesia |
|
Definition
|
|
Term
| for every year above 80 there is a __% increase in mortality for surgery |
|
Definition
|
|
Term
| Why is meperidine avoided in the elderly |
|
Definition
| geriatric patients have a decrease cholinergic reserve and are at more risk from developing side effects from central anticholinergic medications. (cognitive declien, delirium) |
|
|
Term
| name some other anticholinergic meds to avoid in elderly |
|
Definition
1. scopolamine
2. chlorpheniramine
3. promethazine
4. haldol |
|
|
Term
| name a side effect of etomidate |
|
Definition
| myoclonus as a result of dishibitory effects in 30-60% of patients |
|
|
Term
| what dose of etomidate do you give an elderly person |
|
Definition
| Reduce the dose by 50% for etomidate |
|
|
Term
| The MAC for an inhaled anesthetic decreases predictable by how much each year |
|
Definition
| AFter 20 years of age MAC decreases 6% every decade. |
|
|
Term
| does age effect neuromuscular drugs? Does age effect inhaled anesthetics? |
|
Definition
| NO change on NMB but big change on inhaled anesthetics |
|
|
Term
| Which neuromuscular blocker is mostly metabolize in the kidneys and should be avoided in the elderly |
|
Definition
|
|
Term
| what age related changes occurs to elderly |
|
Definition
| stiffening and loss of compliance in the myocardium. Loss of elastin and increase collagin. |
|
|
Term
| Many elderly suffer from this kind of heart dysfunction ___.. Why |
|
Definition
| Diastolic dysfunction b/c of impaired ventricle relaxation. They are dependent on atrial support and preload. Many have hypertrophic hearts from HTN which lead to diastolic dysfunction. |
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|
Term
| Why do elderly have more risks for arrythmias |
|
Definition
| there is more myocardial fribrosis and fatty infiltratoin of the conduction system |
|
|
Term
| what pulmonary changes occur in elderly |
|
Definition
reduced muscle strength, decrease chest wall compliance, decrease elastic recoid, age related ventilation perfusion mismatch, decrease diffusing capacity
- increase susceptiblity to narcotic induced apnea
- decrease hypoxemic and hypercapnic ventilatory drive |
|
|
Term
| most significant neurotransmitter decline in elderly are |
|
Definition
| Serotonoin and acetylcholine in the cortex and dopamine in the neostriata, and dopamine in the substantia nigra and neostriata. |
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|
Term
| what 4x common anesthesia drugs should be reduced by 50% in the elderly |
|
Definition
| 1. versed 2. propofol 3. opioids 4.etomidate |
|
|
Term
| Are there age related changes to NMB and Inhaled gases? |
|
Definition
Yes to inhaled anesthesia
NO to NMB |
|
|
Term
| T/F a patient over the age of 90 should not have surgery |
|
Definition
| FALSE. ADVANCE AGE is not a CONTRAINDICATION FOR SURGERY. What is is multiple comorbidities |
|
|
Term
| what is the relationship between advancing age and organ function |
|
Definition
| increase age then decrease organ function. INVERSE |
|
|
Term
| for surgical patients over 80. there is a ___ % increase in mortality for every ___ year |
|
Definition
| Over 80 there is a 5 % increase every year of mortality compared to the 80 year old person. So a 84 year old for hte same surgery has a 20% higher risk of mortality than the 80 year old for the same thing. |
|
|
Term
| why do we avoid meperidine in elderly patients |
|
Definition
| b/c elderly patients have decreased cholinergic reserve and have higher risk for central anticholinergic medications which are cognitive decline and delirium |
|
|
Term
| list some antihistamines to avoid |
|
Definition
1. chlorpheniramine
2. promethazine |
|
|
Term
| why should high doses of haldol be avoided in edlerly |
|
Definition
| high doses has anticholinergic effects! |
|
|
Term
| Age related changes in organs results in Increase or Decrease reserve capacity of all organs |
|
Definition
|
|
Term
| is there an increase or decrease in storage size for lipid-soluble drugs for elderly |
|
Definition
| INCREASE storage of lipid soluble drugs in elderly |
|
|
Term
| Why do old people have higher resting heart rates |
|
Definition
| due to decrease parasympathetic nervous system tone and increase SNS |
|
|
Term
In the elderly what happens with the chest in terms of
1. height
2. AP diameter |
|
Definition
1. Decrease chest wall height
2. increase AP diameter |
|
|
Term
| in regards to the lungs and chest wall which has increase compliance and which has decreased compliance? or both the same? |
|
Definition
Chest wall: Decrease compliance
Lungs: increase compliance. |
|
|
Term
| what happens with the A-a gradient for elderly |
|
Definition
| increase A-a gradient, and decrease in Pao2 |
|
|
Term
| Since elderly have decrease left ventricle compliance and filling they depend on what for hemodynamic stability |
|
Definition
| They need adequate atrial pressures and the atrial kick to fill the ventricle and push against its stubborn resistance. |
|
|
Term
| Diastolic dysfunction is more common that shown since left heart values are preserved but this does not highlight the problems from having it. What happens to an elderly patient with it who has a fib or fluid overload |
|
Definition
| Left heart in diastolic dysfunction is resistant to filling from the atrium and this causes imedenance. If blood doesnt adequately fill the left ventricle than the BP will drop significantly. So afib means not atrial kick and strong pressure to get blood to left heart. Hemodynamic instability will occur. IF pt is fluid overloaded the left ventricle can't absorb this extra volume to pump out of the circulation so instead it gets distended into the pulmonary vasculature |
|
|
Term
| is beta or alpha adrenergic preserved in elderly |
|
Definition
| alpha is preserved but beta is thrown off |
|
|
Term
| Why are old people more prone to ortho static hypotension |
|
Definition
| due to reduction in the baroreflex function and overall vascular stiffening, and decrease working of beta receptors which leads to sluggish response to increase demand on heart. |
|
|
Term
| What hemodynamic factors do elderly depend on most (2) Contractility? Afterload? Preload? Vascular tone? CO? SV? |
|
Definition
| Preload and Vascular tone!! They need to stay isovolumetric and need their tone. So they don't do well with anesthesia and being NPO!! |
|
|
Term
| what two age related changes predisposes elderly to arrythmias |
|
Definition
1. myocardial fibrosis
2. fatty infiltration of pacemaker cells |
|
|
Term
| what percentage of the population over 75 years of age has cardiac disease |
|
Definition
|
|
Term
| leading cause of congestive heart failure in the elderly is |
|
Definition
|
|
Term
| The majority of deaths of patients is when and related to what for age 65 or older |
|
Definition
| postoperatively related to pulmonary complications in people age 65 or greater |
|
|
Term
| aging pulmonary changes is similar to what disease pathology? What exactly is similar |
|
Definition
emphysema
1. increase size of central airways
2. increase physiological dead space
3. lack of elastic recoil in smaller airways leads to air trapping
4. increase closing capacity
5. Closing capacity > FRC in age >65 |
|
|
Term
| there is a small change in hypoxic and hypercapnea drive in elderly |
|
Definition
| FALSE. Large change by 50% in hypoxia and hypercapnea drive |
|
|
Term
|
Definition
| 60mL/min down from 125 mL/min in young people |
|
|
Term
| is serum creatine not a good indicator of kidney health for elderly |
|
Definition
| NOOOOOOOOOOO....since old people have less protein then checking creatine which reflects protein clearance is a waste since it wont accurately reflect the degree of renal insufficency |
|
|
Term
| what happens with protein levels as a result of decrease livers in elderly and how does this relate to medications |
|
Definition
| decrease proteins, so more free drug if drug otherwise was very protein bound. |
|
|
Term
| does renal or liver take a bigger hit with aging |
|
Definition
|
|
Term
| what patients need an ECG that are elderly |
|
Definition
1. cardiac history
2. history of active cardiac disease |
|
|
Term
| if you suspect __ or ___ then you can get an CXR |
|
Definition
1. pulmonary congestion
2. pneumonia |
|
|
Term
| EKG have high specificity |
|
Definition
|
|
Term
| what drugs to avoid in elderly day of surgery |
|
Definition
1. ace inhibitors
2. ARB
Do not take 12 hours prior to surgery |
|
|
Term
| antidysrhythmics can potentiate what anesthetic |
|
Definition
|
|
Term
| antibiotics can potentiate what anesthetic drugs |
|
Definition
|
|
Term
| Will atropine work the same in elderly? Will you need more or less |
|
Definition
| NEED TO GIVE MORE ATROPINE. Since PNS is not working as well. |
|
|
Term
| why are elderly more incline for dysphagia / aspiration |
|
Definition
| due to decrase in pharyngeal reflexes |
|
|
Term
| maintain BP of elderly within ___% of baseline |
|
Definition
| wihtin 10%!!! they can't handle large fluctuations! REMEMBER PRELOAD AND VASCULAR TONE DEPENDENT |
|
|
Term
| what induction drug can cause myoclonus |
|
Definition
| etomidate, observed in 30%-60% of patients regardless of age |
|
|
Term
| what dose of etomidate do you give an elderly |
|
Definition
|
|
Term
| dose of versed should be reduced by how much in elderly |
|
Definition
|
|
Term
| Change of MAC for elderly is what equation? So what is the MAC goal for someone who is 70? |
|
Definition
| Every decade after 20 there is a change in MAC by 6%. So 30% higher risk compared to 20 year old |
|
|
Term
| does age affect response to NMBD |
|
Definition
| NO! Neuromuscular junction unchanged. |
|
|
Term
| what paralytic should you avoid in the elderly and why |
|
Definition
| avoid pancorunium since it is 85% cleared in the kidneys and all old people have significant decreases in renal function |
|
|
Term
| Is hoffman's elimination altered by aging? |
|
Definition
| NO! so ok to give cisatracurium or atracorium |
|
|
Term
| older adults reduce opioid dose by how much |
|
Definition
| 50%. And avoid all opioids with active metabolites since elderly have decrease renal function |
|
|
Term
| does age affect response to NMBD |
|
Definition
| NO! Neuromuscular junction unchanged. |
|
|
Term
| what paralytic should you avoid in the elderly and why |
|
Definition
| avoid pancorunium since it is 85% cleared in the kidneys and all old people have significant decreases in renal function |
|
|
Term
| Is hoffman's elimination altered by aging? |
|
Definition
| NO! so ok to give cisatracurium or atracorium |
|
|
Term
| older adults reduce opioid dose by how much |
|
Definition
|
|
Term
| what are the two main dynamic concerns in MAC cases with elderly during this ultra short procedures |
|
Definition
1. hypoventilation
2. apnea |
|
|
Term
| T/F There is no difference in mortality between epidural and spinals |
|
Definition
|
|
Term
| What age related change to local in epidurals is of concern |
|
Definition
| They spread more! And like to go cephald |
|
|
Term
| Hypotension with elderly from neuraxial anesthesia is best treated by pressors or fluid? |
|
Definition
| PRESSORS! don't waste your time on fluid b/c pts have poor cardiac reserve and vascular tone |
|
|
Term
| Why should we be cautions giving nsaids to elderly |
|
Definition
1. renal failure exac
2. GI bleeds |
|
|
Term
| dose of local anesthesia should be ___ in elderly |
|
Definition
|
|
Term
| list all causes of delerium |
|
Definition
1. metabolic derrangement to Na
2. hypoxemia
3. anemia
4. uremia
5. sepsis
6. uncontrolled pain
7. disorientation
8. depression
9. anticholinergic medications
10. Alcohol withdrawal |
|
|
Term
|
Definition
| Post operative cognitive dysfunction. Decrease mental function without delerium |
|
|
Term
| use positive end expiratory pressure to maintain FRC above ___ |
|
Definition
| closing capacity. If closing capacity is ever more than FRC than you will have atelectasis and gas trapping which will result in hypoxemia! |
|
|
Term
| maintain FiO2 > ___ % to help prevent infection and PONV |
|
Definition
|
|
Term
| what is closing capacity? What does it mean to have increasing closing capacity? |
|
Definition
| Closing capcacity is the volume at which is needed to prevent all the little lung tissue from collapsing. So if you go any lower they collapse. If you have an increase closing capacity means those lungs require more air present to keep them open. That means less air to exchange. |
|
|
Term
| what diseases increase closing capacity |
|
Definition
1. Age
2. Asthma
3. COPD
4. Emphysema
5. Pulmonary Edema |
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