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Implication of age-related changes on anesthesia management
Elderly patients have a high risk of perioperative morbidity and mortality. Pluri-morbidities, polypharmacy, and functional dependence may have a great impact on intraoperative management and request specific cautions. In addition to surgical stress, several perioperative noxious stimuli such as fas...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10540993/ https://www.ncbi.nlm.nih.gov/pubmed/37779561 http://dx.doi.org/10.4103/sja.sja_579_23 |
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author | Luca, Ersilia Schipa, Chiara Cambise, Chiara Sollazzi, Liliana Aceto, Paola |
author_facet | Luca, Ersilia Schipa, Chiara Cambise, Chiara Sollazzi, Liliana Aceto, Paola |
author_sort | Luca, Ersilia |
collection | PubMed |
description | Elderly patients have a high risk of perioperative morbidity and mortality. Pluri-morbidities, polypharmacy, and functional dependence may have a great impact on intraoperative management and request specific cautions. In addition to surgical stress, several perioperative noxious stimuli such as fasting, blood loss, postoperative pain, nausea and vomiting, drug adverse reactions, and immobility may trigger a derangement leading to perioperative complications. Older patients have a high risk of major hemodynamic derangement due to aging of the cardiovascular system and associated comorbidities. The hemodynamic monitoring as well as fluid therapy should be the most accurate as possible. Aging is accompanied by decreased renal function, which is related to a reduction in renal blood flow, renal mass, and the number and size of functioning nephrons. Drugs eliminated predominantly by the renal route need dosage adjustments based on residual renal function. Liver mass, hepatic blood flow, and intrinsic metabolic activity are decreased in the elderly, and all drugs metabolized by the liver have a variable half-life, thus requiring dose reduction. Decreased neural plasticity contributes to a high risk for postoperative delirium. Monitoring of anesthesia depth should be mandatory to avoid overdosage of hypnotic drugs. Prevention of postoperative pulmonary complications requires both protective ventilation strategies and adequate recovery of neuromuscular function at the end of surgery. Avoidance of hypothermia cannot be missed. The aim of this review is to describe comprehensive strategies for intraoperative management plans tailored to meet the unique needs of elderly surgical patients, thus improving outcomes in this vulnerable population. |
format | Online Article Text |
id | pubmed-10540993 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-105409932023-10-01 Implication of age-related changes on anesthesia management Luca, Ersilia Schipa, Chiara Cambise, Chiara Sollazzi, Liliana Aceto, Paola Saudi J Anaesth Review Article Elderly patients have a high risk of perioperative morbidity and mortality. Pluri-morbidities, polypharmacy, and functional dependence may have a great impact on intraoperative management and request specific cautions. In addition to surgical stress, several perioperative noxious stimuli such as fasting, blood loss, postoperative pain, nausea and vomiting, drug adverse reactions, and immobility may trigger a derangement leading to perioperative complications. Older patients have a high risk of major hemodynamic derangement due to aging of the cardiovascular system and associated comorbidities. The hemodynamic monitoring as well as fluid therapy should be the most accurate as possible. Aging is accompanied by decreased renal function, which is related to a reduction in renal blood flow, renal mass, and the number and size of functioning nephrons. Drugs eliminated predominantly by the renal route need dosage adjustments based on residual renal function. Liver mass, hepatic blood flow, and intrinsic metabolic activity are decreased in the elderly, and all drugs metabolized by the liver have a variable half-life, thus requiring dose reduction. Decreased neural plasticity contributes to a high risk for postoperative delirium. Monitoring of anesthesia depth should be mandatory to avoid overdosage of hypnotic drugs. Prevention of postoperative pulmonary complications requires both protective ventilation strategies and adequate recovery of neuromuscular function at the end of surgery. Avoidance of hypothermia cannot be missed. The aim of this review is to describe comprehensive strategies for intraoperative management plans tailored to meet the unique needs of elderly surgical patients, thus improving outcomes in this vulnerable population. Wolters Kluwer - Medknow 2023 2023-08-18 /pmc/articles/PMC10540993/ /pubmed/37779561 http://dx.doi.org/10.4103/sja.sja_579_23 Text en Copyright: © 2023 Saudi Journal of Anesthesia https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Review Article Luca, Ersilia Schipa, Chiara Cambise, Chiara Sollazzi, Liliana Aceto, Paola Implication of age-related changes on anesthesia management |
title | Implication of age-related changes on anesthesia management |
title_full | Implication of age-related changes on anesthesia management |
title_fullStr | Implication of age-related changes on anesthesia management |
title_full_unstemmed | Implication of age-related changes on anesthesia management |
title_short | Implication of age-related changes on anesthesia management |
title_sort | implication of age-related changes on anesthesia management |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10540993/ https://www.ncbi.nlm.nih.gov/pubmed/37779561 http://dx.doi.org/10.4103/sja.sja_579_23 |
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