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Geriatric Anaesthesia

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Advanced Age Geriatric Care

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Abstract

Anaesthesia and surgery are often associated with increased morbidity and mortality in the elderly. Today, innovations in science and engineering in combination with a system approach to safety and training have made anaesthesia safe in the very old. This chapter will review the effects of age-related physiological changes and altered pharmacokinetics on the anaesthetic drugs and techniques in the elderly. It will cover broad principles of anaesthesia as they apply to the elderly. Age-related changes, for instance, may cause a reduction in anaesthetic requirements due to reduced neuronal mass and weakness of the skeletal muscles, whilst changes in the respiratory system may impact on perioperative assessment and postoperative care. With an ageing population, frailty, coexisting medical problems, the urgency of surgery and the type of surgical procedures have become the important determinants of outcome. The chapter also outlines the common postoperative complications in the elderly. The process of preoperative evaluation and risk assessment is also outlined.

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References

  1. Siegel-Itzkovich T. So it doesn’t hurt: 170 years of anaesthesia-business & innovation-Jerusalem post. http://www.jpost.com/Business-and-Innovation/Health-and-Science/So-it-doesn't-hurt-170-years-of-anaethesia-471185. Accessed 8 May 2017.

  2. Kavanagh MF. The origin of the word “anesthesia”. http://ncbi.nim.nih.gov/pmc/articles/PMC1655772/?pag=1. Accessed 8 May 2017.

  3. Miller AH. The origin of the word ‘Anaesthesia’. Boston Med Surg J. 1927;197:1218–22.

    Google Scholar 

  4. Robinson DH, Toledo AH. Historical development of modern anaesthesia. J Invet Surg. 2012;25(3):141–9.

    Article  Google Scholar 

  5. Podwinska E, Josko J, Kucewicz-Czech E, Misiolek H, Szozoda M. Pioneers of anaesthesiology-Arthur Ernest Guedel (1883-1956). Anesteziol Interns Ter. 2008;40(3):192–4.

    Google Scholar 

  6. Beroni AG, Handley WG, Massing MW, Bonds DE, Burke GL, Gott DC Jr. Heart failure prevalence incidence and mortality in the elderly with diabetes. Diabetes Care. 2004;27(3):699–703.

    Article  Google Scholar 

  7. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993;22(4 Suppl A):6a–13a.

    Article  CAS  Google Scholar 

  8. Barnett S. Anaesthesia for the older adult. UpToDate https://222.uptodate.com/contents/anaesthesia-for-the-older-adult. Accessed 8 May 2017.

  9. Priebe HJ. The aged cardiovascular risk patient. Br J Anaesth. 2000;85:763–78.

    Article  CAS  Google Scholar 

  10. Cheitlin MD. Cardiovascular physiology-changes with aging. Am J Geriatr Cardiol. 2003;12(1):9–13e.

    Article  Google Scholar 

  11. Anversa PT, Sonnenblick FH, Olivetti G, Megs LG, Capasso JM, et al. Myocyte cell loss and myocyte cellular hyperplasia in hypertrophied ageing rat heart. Circ Res. 1990;67:871–85.

    Article  CAS  Google Scholar 

  12. Lakatta EG. Cardiovascular ageing in health. Clin Geriatr Med. 2000;16:1419–44.

    Article  Google Scholar 

  13. Bansal T, Malhotra N, Hooda S. Anaesthetic considerations in elderly. Int J Pharma Bio Sci. 2012;3:141-1–49.

    Google Scholar 

  14. Pugh KG, Wei JY. Clinical implications of physiological changes in the ageing heart. Drugs Aging. 2001;18(4):263–76.

    Article  CAS  Google Scholar 

  15. Kanonidou Z, Karystianou G. Anaesthesia for the elderly. Hip. 2007;11(4):175–7.

    CAS  Google Scholar 

  16. Nassimiha D, Aronow WS, Ahn C, Goldman ME. Association of coronary risk factors with progression of valvular aortic stenosis in older persons. Am J Cardiol. 2001;87:313–4.

    Google Scholar 

  17. Rooke GA. Cardiovascular aging and anaesthetic implications. J Cardiothorac Vasc Anesth. 2003;17:512–23.

    Article  Google Scholar 

  18. Aalami OO, Fang TD, Sang HM, Nacamuli RP. Physiological features of aging persons. Arch Surg. 2003;138:1068–76.

    Article  Google Scholar 

  19. Ramly E, Kaafarani H, Velmahos G. The effect of aging on pulmonary function – implications for monitoring and Support of the surgical and trauma patient. Surg Clin North Am. 2015;95(1):53–69.

    Article  Google Scholar 

  20. Taylor BJ, Johnson BD. The pulmonary circulation and exercise responses in the elderly. Semin-Respir Crit Care Med. 2010;137(3):411–8.

    Google Scholar 

  21. Oyarzun GM. Pulmonary function in ageing. Rev Med Chil. 2009;137(3):41–8.

    Article  Google Scholar 

  22. Klotz U. Pharmacokinetics and drug metabolism in the elderly. Drug Metab Rev. 2009;41(2):67076.

    Article  Google Scholar 

  23. Fulop T Jr, Worum I, Csongor J, et al. Body composition in elderly people. I. Determination of body composition by multi-isotope method and the elimination kinetics of these isotopes in healthy elderly subjects. Gerontology. 1985;31:6–14.

    Article  Google Scholar 

  24. Mitenko PA. Drug monitoring in the elderly. Clin Biochem. 1986;19(2):145–9.

    Article  CAS  Google Scholar 

  25. El Desoky ES. Pharmakinetic and pharmacodynamic crisis in the elderly. Am J Ther. 2007;14:488–98.

    Article  Google Scholar 

  26. Turheim K. Drug dosage in the elderly. Is it rational? Drugs Aging. 1998;13(5):357–79.

    Article  Google Scholar 

  27. Shi S, Klotz U. Age-related changes in pharmacokinetics. Curr Drug Metab. 2011;12(7):601–10.

    Article  CAS  Google Scholar 

  28. Turnheim K. When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly. Exp Gerontol. 2003;38(8):843–53.

    Article  CAS  Google Scholar 

  29. Ramsay LE, Tucker GT. Drugs and the elderly. BMJ. 1981;282:125–7.

    Article  CAS  Google Scholar 

  30. Schmucker DL. Liver function and phase I drug metabolism in the elderly: a paradox. Drugs Aging. 2001;18(11):837–51.

    Article  CAS  Google Scholar 

  31. Anantharaju A, Feller A, Chedid A. A review. Gerontology. 2002;48:343–53.

    Article  CAS  Google Scholar 

  32. Schmucker DL. Aging and the liver: an update. Gerontol Biol Sci Med Sci. 1998;53:B315–20.

    Article  CAS  Google Scholar 

  33. Lamy P. Comparative pharmacokinetic changes and drug therapy in an older population. J Am Geriatr Soc. 1982;30(Suppl):S11–9.

    Article  CAS  Google Scholar 

  34. Cusack BJ. Pharmacokintics in older persons. Am J Pharm. 2004;2(4):274–302.

    CAS  Google Scholar 

  35. Crooks J, O’Malley K, Stevenson IH. Pharmacokinetics in the elderly. Clin Pharmacokinet. 1976;1(4):280–96.

    Article  CAS  Google Scholar 

  36. Mangoni AA, Jackson SHD. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol. 2004;57(1):6–14.

    Article  CAS  Google Scholar 

  37. Strom C, Rasmussen LS, Steinmetz J. Practical Management of Anaesthesia in the elderly. Drugs Aging. 2016;33:765–77.

    Article  Google Scholar 

  38. Bettelli G. Anaesthesia for elderly outpatient: preoperative assessment and evaluation anaesthetic techniques and postoperative pain management. Curr Opin Anaesthesiol. 2010;23:726–31.

    Article  Google Scholar 

  39. Chu CC, Weng SF, Chen KT, Chien CC, Shieh JP, Chen JY, Wang JJ. Propensity score-matched comparison of postoperative adverse outcomes between geriatric patients given a general or a Neuraxial Anaesthetic for hip surgery: a population-based study. Anesthesiology. 2015;123(1):136.

    Article  Google Scholar 

  40. Partridge JS, Harari D, Martin FC, Dhesi JK. The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. Anaesthesia. 2014;69 Suppl 1:8–16.

    Article  CAS  Google Scholar 

  41. Owcznk R. Guidelines for general anaesthesia in the elderly of the committee on quality and safety in anaesthesia. Polish Soc Anaesthesiol Intens Ther. 2013;45(2):57–61.

    Article  Google Scholar 

  42. Lee TH, Marcantouro ER, Magione CM, Thomas EJ, Polanczykca CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major non-cardiac surgery. Circulation. 1999;100(10):1043–9.

    Article  CAS  Google Scholar 

  43. Grasso AW, Jaber WA Cardiac risk stratification for non-cardiac surgery. Cleveland Clinic. 2014. http://wwwclevelandclinicmedcom/medicalpubs/diseasemanagement/cardiology/cardiac-risk-stratification-fornon-cardiac surgery/. Accessed 28 May 2017.

  44. Leppo JA. Preoperative cardiac risk assessment for non-cardiac surgery. Am J Cardiol. 1995;75(11):42D.

    Article  CAS  Google Scholar 

  45. NICE Guidelines. https://www.nice.org.uk/guidance/ng45/chapter/Recommendation. Accessed 5 June 2016.

  46. Maddox TM. Preoperative cardiovascular evaluation for noncardiac surgery. Mt Sinai J Med. 2005;72(3):185–92.

    PubMed  Google Scholar 

  47. Covert CR, Fox GS. Anaesthesia for hip surgery. Canad J Anaesthesia. 1989;36(3):311–9.

    Article  CAS  Google Scholar 

  48. Hung WW, Egol KA, Zuckerman JD, Siu AL. Hip fracture management: tailoring care for the older patient. JAMA. 2012;307(20):21.

    Article  Google Scholar 

  49. Morrisson RS, Chassin MR, Siu AL. The medical consultant’s role in caring for patients with hip fracture. Ann Intern Med. 1998;128(12 Pt 1):1010–20.

    Article  Google Scholar 

  50. Polderman D, Bax JJ, Boersma E, de Hart S, Eeckhout E, Fowkws G, et al. Guidelines for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur J Anaesthesiol. 2010;27:92–137.

    Article  Google Scholar 

  51. Fitz-Henry J. The ASA classification and peri-opertive risk. Ann R Coll Surg.Engl.2011;93(3):185–7.

    Google Scholar 

  52. Pinaud M. Evaluation of the cardiac risks in non-cardiac surgery in patients with heart failure. Arch Mal Coeur Vaiss. 2002;95 Spec 4(5):21–6.

    Google Scholar 

  53. Hall D, Arya S, Schmid K, et al. Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surg. 2017;152(3):233–40.

    Article  Google Scholar 

  54. Caison JL, Terrin ML, Noreck H, Sanders DW, Chsitman BR, Rhonds GG, et al. Liberal or restrictive transfusion in high risk patients after hip surgery. NEJM. 2011;365:2453–62.

    Article  Google Scholar 

  55. Willett LR, Carson JL. Management of postoperative complications: anaemia. Clin Geriatr Med. 2014;30:279–84.

    Article  Google Scholar 

  56. Sanguineti VA, Wild JR, Fain MJ. Management of postoperative complications: general approach. Clin Geriatr Med. 2014;30:261–70.

    Article  Google Scholar 

  57. Kim S, Brooks AK. Groban L preoperative assessment of the older surgical patient: honing in on geriatric syndromes. Clin Interv Aging. 2014;10:13–27.

    PubMed  PubMed Central  Google Scholar 

  58. Berger M, Nadler JW, Browndyke J, Terrando N, Ponnusamy V, Cohen HJ, Whitson HE, Mathew JP. Postoperative cognitive dysfunction. Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly Anesthesiol Clin. 2015;33(3):517–50.

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine, Townsville Hospital, Townsville, QLD, Australia

    Sivagnanavel Senthuran

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Nages Nagaratnam

Authors
  1. Sivagnanavel Senthuran
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  2. Nages Nagaratnam
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Editor information

Editors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Nages Nagaratnam

  2. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Kujan Nagaratnam

  3. Rehabilitation and Aged Care Service, Blacktown-Mt Druitt Hospital, Blacktown, NSW, Australia

    Gary Cheuk

Multiple Choice Questions (MCQs)

Multiple Choice Questions (MCQs)

  1. 1.

    The following regarding altered pharmacokinetics with ageing are true Except:

    1. A.

      Decrease in total body water affects volume distribution resulting in water-soluble drugs attaining a higher serum levels.

    2. B.

      Increase in body fat with ageing results in fat-soluble drugs having their half-life increased.

    3. C.

      Reduction of liver mass and blood flow with ageing results in decreased rate of drug clearance by the liver.

    4. D.

      Serum creatinine is an accurate reflection of renal impairment in the elderly.

  2. 2.

    The following regarding altered pharmacokinetics with ageing are true Except:

    1. A.

      The elderly are three times more susceptible to ADRs than those younger than 5 years.

    2. B.

      The elderly on multiple drugs have decreased adherence to drug regimes.

    3. C.

      Reduction in renal function affects not only renally excreted drugs but also drugs that undergo extensive metabolism in the liver.

    4. D.

      Some effects may be increased in the elderly, for example, the heart rate response and a higher antihypertensive response than the young to beta-blockers.

Answers to MCQs

  1. 1.

    D

  2. 2.

    D

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Senthuran, S., Nagaratnam, N. (2019). Geriatric Anaesthesia. In: Nagaratnam, N., Nagaratnam, K., Cheuk, G. (eds) Advanced Age Geriatric Care. Springer, Cham. https://doi.org/10.1007/978-3-319-96998-5_9

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  • DOI: https://doi.org/10.1007/978-3-319-96998-5_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96997-8

  • Online ISBN: 978-3-319-96998-5

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