Dr. Rowan Molnar | #DrRowanMolnar: Anaesthesia in elderly patients

Posted by Molnar on September 30th, 2015

Aging brings with it degenerative changes in the structure and function of organs and tissues. When it comes to medicines and surgery, geriatric patients are more sensitive to anaesthetic agents. In most cases, they require less medication while the drug effect is prolonged. The objective of peri-operative care in this case is to induce a speedy recovery and avoid any risk of decline in bodily functions.

Neurological considerations

According to Dr. Rowan Molnar (#DrRowanMolnar), the Head of Discipline at the Head of Discipline, at the University of Tasmania Clinical School, Launceston Campus, there are several factors to keep in mind when dealing with elderly patients. To begin with, there are several changes associated with aging. This includes neurologic, cardiovascular, pulmonary, renal, hepatic, pharmacologic, and blood pressure, to name a few. In terms of neurology and anaesthesia, as brain mass declines with age, post-operative delirium and reduced cognitive function are much higher in geriatric patients. Therefore, general requirements for anaesthesia can reduce by as much as 30 percent, which is possibly due to the loss of neurons or the increased threshold for stimulation of the senses. There is also a significant reduction in the dose of local anaesthesia in spinals and epidurals.

Cardiovascular considerations

Dr. Rowan Molnar (#DrRowanMolnar) also stresses the fact that elderly patients have reduced cardiac output and experience increased incidences of hypertension, bradyarrythmias, and abnormalities. Therefore, preoperative risk assessment must focus on patient functional capacity of more than four metabolic equivalents, surgical risk for cardiac events after the procedure, and risk indices. A decrease in vascular compliance and diastolic dysfunctionalso makes elderly patients compensate poorly for hypo-volemia or the decrease in blood plasma volume. It is also important to carefully consider fluid administration since elderly patients rely more on the Frank-Starling law of the heart for cardiac output.

Postoperative pain management

Postoperative pain usually last for over 3 days and can affect quality of life for over a week. When it comes to geriatric day surgery, it is important that the patient be given clear instructions prior to discharge. The availability of analgesics and follow up are also key factors. Some geriatric patients may refrain from reporting postoperative pain due to cognitive impairment while dementia or aphasia could make pain assessment even more difficult. Local anaesthetics play a major role both individually and as part of the anaesthesia plan. In geriatric patients, there is an increased risk of gastric complications with NSAIDs that are effective for light to moderate pain. On the other hand, acetaminophen is widely used due to its high safety level while minor opoids are also known to be well tolerated.

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