Geriatric Anesthesia, An Issue of Anesthesiology Clinics

Charles Brown

Description

The volume of elderly patients requiring anesthesia and surgery is growing rapidly. Thirty-five percent of surgeries are performed on patients older than 65 years, and in general, these patients have higher morbidity and mortality rates after anesthesia compared with their younger counterparts. One of the major challenges of treating elderly patients is the heterogeneity of the geriatric population—and the need to individualize care for each patient to provide the best outcome.

Sujets

• Médecine
• Spécialités médicales
• Médecine Générale
• Anesthesiology
• Medical

Informations

• Publié par: Elsevier
• Date de parution: 22 juillet 2016
• Nombre de lectures: 0
• EAN13: 9780323395526
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Clinics Review Articles Anesthesiology Clinics
Geriatric Anesthesia

Charles H. Brown, IV. MD, MHS
Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

Mark D. Neuman, MD, MSc
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
ISSN  1932-2275 Volume 33 • Number 3 • September 2015
Elsevier
Table of Contents
Cover image
Title page
Copyright Page
Contributors
Consulting Editor
Editors
Authors
Forthcoming Issues
Forthcoming Issues
Recent Issues
Foreword: Geriatric Anesthesia: Can We Achieve the Goal of Returning our Elderly to Baseline or Improved Function?
Preface: Optimizing Perioperative Care for Older Adults
The History of Geriatric Anesthesia in the United States and the Society for the Advancement of Geriatric Anesthesia
Key points
Introduction
The early years
American Society of Anesthesiologists Committee on Geriatric Anesthesia
Society for the Advancement of Geriatric Anesthesia
Involvement by the American Geriatrics Society
American Society of Anesthesiologists involvement
Future considerations
Geriatrics and the Perioperative Surgical Home
Key points
Introduction
Definition of the perioperative surgical home
Triple aim
Where to start?
Benefits of the perioperative surgical home
Aging patient population
Role in geriatrics
Complications in the geriatric population: room for improvement?
Future considerations/summary
Physiology Considerations in Geriatric Patients
Key points
Introduction
Nervous system
Cardiovascular system
Respiratory system
Gastrointestinal system
Renal and volume regulation system
Endocrine system
Summary
Geriatric Pharmacology
Key points
Introduction
Cerebral mechanisms of general anesthesia
Pharmacokinetic changes with aging
Pharmacologic considerations of specific anesthetic medications
Applying pharmacologic knowledge to practice
Consequences of overdosing anesthetics in elderly patients
Summary
Preoperative Assessment of Geriatric Patients
Key points
Introduction
Neuropsychiatric evaluation
Cardiac evaluation
Pulmonary evaluation
Frailty
Functional status
Nutritional status
Medication history and polypharmacy
Diagnostic tests
Patient counseling
Future considerations/summary
Optimal Preoperative Evaluation and Perioperative Care of the Geriatric Patient
Key points
Introduction
The American College of Surgeons/American Geriatrics Society best practice guidelines
The complete meal: best practices and more
The à la carte menu: more practical options for some
Summary
Anesthetic Considerations for Common Procedures in Geriatric Patients
Key points
Introduction
General approach to anesthetic management in the elderly patient
Anesthetic considerations for hip fractures
Anesthetic considerations for emergent general surgery
Anesthetic considerations for transcatheter aortic valve replacement
Future directions
Postoperative Delirium in the Geriatric Patient
Key points
Introduction
Risk factors
Diagnosis
Pathophysiology
Management
Current controversies and future considerations
Summary
Postoperative Cognitive Dysfunction
Key points
A description of postoperative cognitive dysfunction and postoperative cognitive improvement
Who is at risk for developing postoperative cognitive dysfunction?
What causes postoperative cognitive dysfunction?
How can we prevent or treat postoperative cognitive dysfunction?
Summary and future directions
Critical Care Issues of the Geriatric Patient
Key points
Introduction
Epidemiology and impact
Neurologic system
Cardiovascular system
Pulmonary system
Renal system
Frailty
Geriatric trauma
Summary
Pain Management Issues for the Geriatric Surgical Patient
Key points
Risks of pain treatment
Measurement of pain
Physiologic changes in the older adult
Opioid metabolism
Initiating treatment
Opioids
Chronic pain and opioids in the geriatric patient
Multimodal analgesia
Nonopioid adjuvants
What not to use: the Beers Criteria
Regional analgesic techniques
Summary
Chronic Pain in Older Adults
Key points
Introduction
Age-related differences relevant to pain
Pain assessment in older adults
Pain management in older adults
Summary
Palliative Care for the Geriatric Anesthesiologist
Key points
Introduction
Palliative care
End-of-life care and hospice
Palliative care–related perioperative issues
Ongoing controversies in palliative medicine
Integrating palliative care and perioperative care for older adults
Summary
Index
Copyright Page
Elsevier
1600 John F. Kennedy Boulevard • Suite 1800 • Philadelphia, Pennsylvania, 19103-2899
http://www.theclinics.com
ANESTHESIOLOGY CLINICS Volume 33, Number 3
September 2015 ISSN 1932-2275, ISBN-13: 978-0-323-39551-9
Editor: Patrick Manley
Developmental Editor: Kristen Helm
© 2015 Elsevier Inc. All rights reserved.
This periodical and the individual contributions contained in it are protected under copyright by Elsevier, and the following terms and conditions apply to their use:
Photocopying
Single photocopies of single articles may be made for personal use as allowed by national copyright laws. Permission of the Publisher and payment of a fee is required for all other photocopying, including multiple or systematic copying, copying for advertising or promotional purposes, resale, and all forms of document delivery. Special rates are available for educational institutions that wish to make photocopies for non-profit educational classroom use. For information on how to seek permission visit www.elsevier.com/permissions or call: ([phone] (UK)/([phone] (USA).
Derivative Works
Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internal circulation within their institutions. Permission of the Publisher is required for resale or distribution outside the institution. Permission of the Publisher is required for all other derivative works, including compilations and translations (please consult www.elsevier.com/permissions ).
Electronic Storage or Usage
Permission of the Publisher is required to store or use electronically any material contained in this periodical, including any article or part of an article (please consult www.elsevier.com/permissions ). Except as outlined above, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the Publisher.
Notice
No responsibility is assumed by the Publisher for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.
Although all advertising material is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer.
Anesthesiology Clinics (ISSN 1932-2275) is published quarterly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Months of issue are March, June, September, and December. Periodicals postage paid at New York, NY and at additional mailing offices. Subscription prices are $160.00 per year (US student/resident), $330.00 per year (US individuals), $400.00 per year (Canadian individuals), $533.00 per year (US institutions), $674.00 per year (Canadian institutions), $225.00 per year (Canadian and foreign student/resident), $455.00 per year (foreign individuals), and $674.00 per year (foreign institutions). To receive student and resident rate, orders must be accompanied by name of affiliated institution, date of term, and the signature of program/residency coordinator on institutions letterhead. Orders will be billed at individual rate until proof of status is received. Foreign air speed delivery is included in all Clinics’ subscription prices. All prices are subject to change without notice. POSTMASTER: Send address changes to Anesthesiology Clinics, Elsevier Health Sciences Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043. Customer Service (orders, claims, online, change of address): Elsevier Health Sciences Division, Subscription Customer Service, 3251 Riverport Lane, Maryland Heights, MO 63043. Tel:[phone] (U.S. and Canada); 314-447-8871 (outside U.S. and Canada). Fax: [phone]. E-mail: [e-mail] (for print support) ; [e-mail] (for online support) .
Reprints . For copies of 100 or more of articles in this publication, please contact the Commercial Reprints Department, Elsevier Inc., 360 Park Avenue South, New York, NY 10010-1710. Tel.: [phone]; Fax: [phone]; E-mail: [e-mail] .
Anesthesiology Clinics, is also published in Spanish by McGraw-Hill Inter-americana Editores S. A., P.O. Box 5-237, 06500 Mexico D. F., Mexico.
Anesthesiology Clinics , is covered in MEDLINE/PubMed (Index Medicus), Current Contents/Clinical Medicine, Excerpta Medica, ISI/BIOMED , and Chemical Abstracts .
Printed in the United States of America.
Contributors

Consulting Editor
LEE A. FLEISHER, MD, FACC, FAHA
Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care, Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Editors
CHARLES H. BR