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Book Details
Abstract
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.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Geriatric Anesthesia | i | ||
| Copyright | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Geriatric Anesthesia: Can We Achieve the Goal of Returning our Elderly to Baseline or Improved Function? | vii | ||
| Preface: Optimizing Perioperative Care for Older Adults | vii | ||
| The History of Geriatric Anesthesia in the United States and the Society for the Advancement of Geriatric Anesthesia | vii | ||
| Geriatrics and the Perioperative Surgical Home | vii | ||
| Physiology Considerations in Geriatric Patients | vii | ||
| Geriatric Pharmacology | viii | ||
| Preoperative Assessment of Geriatric Patients | viii | ||
| Optimal Preoperative Evaluation and Perioperative Care of the Geriatric Patient: A Surgeon’s Perspective | viii | ||
| Anesthetic Considerations for Common Procedures in Geriatric Patients: Hip Fracture, Emergency General Surgery, and Transca ... | viii | ||
| Postoperative Delirium in the Geriatric Patient | ix | ||
| Postoperative Cognitive Dysfunction: Minding the Gaps in Our Knowledge of a Common Postoperative Complication in the Elderly | ix | ||
| Critical Care Issues of the Geriatric Patient | ix | ||
| Pain Management Issues for the Geriatric Surgical Patient | x | ||
| Chronic Pain in Older Adults | x | ||
| Palliative Care for the Geriatric Anesthesiologist | x | ||
| ANESTHESIOLOGY CLINICS | xi | ||
| FORTHCOMING ISSUES | xi | ||
| December 2015 | xi | ||
| March 2016 | xi | ||
| June 2016 | xi | ||
| RECENT ISSUES | xi | ||
| June 2015 | xi | ||
| March 2015 | xi | ||
| December 2014 | xi | ||
| Geriatric Anesthesia: Can We Achieve the Goal of Returning our Elderly to Baseline or Improved Function? | xiii | ||
| Optimizing Perioperative Care for Older Adults | xv | ||
| The History of Geriatric Anesthesia in the United States and the Society for the Advancement of Geriatric Anesthesia | 427 | ||
| Key points | 427 | ||
| INTRODUCTION | 427 | ||
| THE EARLY YEARS | 428 | ||
| AMERICAN SOCIETY OF ANESTHESIOLOGISTS COMMITTEE ON GERIATRIC ANESTHESIA | 428 | ||
| SOCIETY FOR THE ADVANCEMENT OF GERIATRIC ANESTHESIA | 429 | ||
| INVOLVEMENT BY THE AMERICAN GERIATRICS SOCIETY | 432 | ||
| AMERICAN SOCIETY OF ANESTHESIOLOGISTS INVOLVEMENT | 434 | ||
| FUTURE CONSIDERATIONS | 434 | ||
| REFERENCES | 435 | ||
| Geriatrics and the Perioperative Surgical Home | 439 | ||
| Key points | 439 | ||
| INTRODUCTION | 439 | ||
| DEFINITION OF THE PERIOPERATIVE SURGICAL HOME | 440 | ||
| TRIPLE AIM | 441 | ||
| WHERE TO START? | 442 | ||
| BENEFITS OF THE PERIOPERATIVE SURGICAL HOME | 442 | ||
| AGING PATIENT POPULATION | 442 | ||
| ROLE IN GERIATRICS | 443 | ||
| COMPLICATIONS IN THE GERIATRIC POPULATION: ROOM FOR IMPROVEMENT? | 443 | ||
| FUTURE CONSIDERATIONS/SUMMARY | 444 | ||
| REFERENCES | 444 | ||
| Physiology Considerations in Geriatric Patients | 447 | ||
| Key points | 447 | ||
| INTRODUCTION | 447 | ||
| NERVOUS SYSTEM | 448 | ||
| CARDIOVASCULAR SYSTEM | 449 | ||
| RESPIRATORY SYSTEM | 451 | ||
| GASTROINTESTINAL SYSTEM | 452 | ||
| RENAL AND VOLUME REGULATION SYSTEM | 453 | ||
| ENDOCRINE SYSTEM | 454 | ||
| SUMMARY | 455 | ||
| REFERENCES | 455 | ||
| Geriatric Pharmacology | 457 | ||
| Key points | 457 | ||
| INTRODUCTION | 457 | ||
| CEREBRAL MECHANISMS OF GENERAL ANESTHESIA | 458 | ||
| PHARMACOKINETIC CHANGES WITH AGING | 459 | ||
| Body Composition | 459 | ||
| Metabolism | 460 | ||
| PHARMACOLOGIC CONSIDERATIONS OF SPECIFIC ANESTHETIC MEDICATIONS | 460 | ||
| Inhalational Anesthetics | 460 | ||
| Propofol | 461 | ||
| Etomidate | 461 | ||
| Thiopental | 463 | ||
| Midazolam | 463 | ||
| Opioids | 463 | ||
| Fentanyl | 463 | ||
| Remifentanil | 463 | ||
| Meperidine | 464 | ||
| Neuromuscular Blocking Drugs | 464 | ||
| APPLYING PHARMACOLOGIC KNOWLEDGE TO PRACTICE | 464 | ||
| CONSEQUENCES OF OVERDOSING ANESTHETICS IN ELDERLY PATIENTS | 465 | ||
| SUMMARY | 466 | ||
| REFERENCES | 466 | ||
| Preoperative Assessment of Geriatric Patients | 471 | ||
| Key points | 471 | ||
| INTRODUCTION | 471 | ||
| NEUROPSYCHIATRIC EVALUATION | 472 | ||
| CARDIAC EVALUATION | 474 | ||
| PULMONARY EVALUATION | 474 | ||
| FRAILTY | 476 | ||
| FUNCTIONAL STATUS | 477 | ||
| NUTRITIONAL STATUS | 478 | ||
| MEDICATION HISTORY AND POLYPHARMACY | 478 | ||
| DIAGNOSTIC TESTS | 478 | ||
| PATIENT COUNSELING | 479 | ||
| FUTURE CONSIDERATIONS/SUMMARY | 479 | ||
| REFERENCES | 479 | ||
| Optimal Preoperative Evaluation and Perioperative Care of the Geriatric Patient | 481 | ||
| Key points | 481 | ||
| INTRODUCTION | 481 | ||
| THE AMERICAN COLLEGE OF SURGEONS/AMERICAN GERIATRICS SOCIETY BEST PRACTICE GUIDELINES | 483 | ||
| THE COMPLETE MEAL: BEST PRACTICES AND MORE | 483 | ||
| THE À LA CARTE MENU: MORE PRACTICAL OPTIONS FOR SOME | 485 | ||
| Who Performs the Evaluation | 485 | ||
| Location of the Evaluation | 485 | ||
| Dataset of Tests | 485 | ||
| Location of the Data | 485 | ||
| Prospective or Retrospective | 486 | ||
| SUMMARY | 486 | ||
| REFERENCES | 487 | ||
| Anesthetic Considerations for Common Procedures in Geriatric Patients | 491 | ||
| Key points | 491 | ||
| INTRODUCTION | 491 | ||
| GENERAL APPROACH TO ANESTHETIC MANAGEMENT IN THE ELDERLY PATIENT | 492 | ||
| Focused History and Physical | 492 | ||
| Consider Pharmacologic Differences | 492 | ||
| Consider the Systems-Based Changes Associated with Aging | 492 | ||
| ANESTHETIC CONSIDERATIONS FOR HIP FRACTURES | 493 | ||
| Immediate Preoperative Considerations | 493 | ||
| General Versus Regional Anesthesia | 493 | ||
| Pharmacologic Considerations | 494 | ||
| ANESTHETIC CONSIDERATIONS FOR EMERGENT GENERAL SURGERY | 494 | ||
| Immediate Preoperative Considerations | 494 | ||
| Intraoperative Considerations | 495 | ||
| Pharmacologic Considerations | 495 | ||
| Airway | 495 | ||
| Breathing | 496 | ||
| Circulation | 496 | ||
| Renal and electrolyte | 496 | ||
| Hepatic | 496 | ||
| Endocrine | 496 | ||
| Positioning | 496 | ||
| Postoperative Period | 496 | ||
| ANESTHETIC CONSIDERATIONS FOR TRANSCATHETER AORTIC VALVE REPLACEMENT | 497 | ||
| Patient Selection | 498 | ||
| Immediate Preoperative Considerations | 498 | ||
| Anesthetic Management: General Anesthesia Versus Procedural Sedation | 498 | ||
| Airway | 499 | ||
| Breathing | 499 | ||
| Circulation | 499 | ||
| Disability | 499 | ||
| Renal | 499 | ||
| Endocrine | 499 | ||
| Positioning and skin | 499 | ||
| FUTURE DIRECTIONS | 499 | ||
| REFERENCES | 500 | ||
| Postoperative Delirium in the Geriatric Patient | 505 | ||
| Key points | 505 | ||
| INTRODUCTION | 505 | ||
| RISK FACTORS | 506 | ||
| DIAGNOSIS | 506 | ||
| Clinical Features | 507 | ||
| Screening Tools | 507 | ||
| PATHOPHYSIOLOGY | 507 | ||
| Neuroinflammation | 508 | ||
| Oxidative Stress | 508 | ||
| MANAGEMENT | 510 | ||
| CURRENT CONTROVERSIES AND FUTURE CONSIDERATIONS | 511 | ||
| Use of Ketamine | 511 | ||
| Use of Antipsychotics | 511 | ||
| Potential Biomarkers | 512 | ||
| SUMMARY | 512 | ||
| REFERENCES | 512 | ||
| Postoperative Cognitive Dysfunction | 517 | ||
| Key points | 517 | ||
| A DESCRIPTION OF POSTOPERATIVE COGNITIVE DYSFUNCTION AND POSTOPERATIVE COGNITIVE IMPROVEMENT | 518 | ||
| What Is Postoperative Cognitive Dysfunction? | 518 | ||
| How Long Does Postoperative Cognitive Dysfunction Last? | 524 | ||
| What Is Postoperative Cognitive Improvement? | 526 | ||
| How Long Does Postoperative Cognitive Improvement Last? | 527 | ||
| A Comparison Between Postoperative Cognitive Dysfunction and Other Medically Related/Induced Cognitive Disorders | 527 | ||
| WHO IS AT RISK FOR DEVELOPING POSTOPERATIVE COGNITIVE DYSFUNCTION? | 527 | ||
| Modifiable Risk Factors | 527 | ||
| Nonmodifiable Risk Factors | 537 | ||
| WHAT CAUSES POSTOPERATIVE COGNITIVE DYSFUNCTION? | 537 | ||
| Animal Models | 537 | ||
| Human Studies | 538 | ||
| HOW CAN WE PREVENT OR TREAT POSTOPERATIVE COGNITIVE DYSFUNCTION? | 539 | ||
| Postoperative Cognitive Dysfunction Prevention Studies | 539 | ||
| Postoperative Cognitive Dysfunction Treatment Studies | 540 | ||
| SUMMARY AND FUTURE DIRECTIONS | 541 | ||
| ACKNOWLEDGEMENTS | 541 | ||
| REFERENCES | 541 | ||
| Critical Care Issues of the Geriatric Patient | 551 | ||
| Key points | 551 | ||
| INTRODUCTION | 551 | ||
| EPIDEMIOLOGY AND IMPACT | 551 | ||
| NEUROLOGIC SYSTEM | 552 | ||
| Pain | 552 | ||
| Delirium | 553 | ||
| CARDIOVASCULAR SYSTEM | 553 | ||
| Arrhythmias | 553 | ||
| Valvular Disease | 554 | ||
| Coronary Disease | 554 | ||
| Congestive Heart Failure | 554 | ||
| Cardiopulmonary Resuscitation | 555 | ||
| PULMONARY SYSTEM | 555 | ||
| Respiratory Failure | 555 | ||
| RENAL SYSTEM | 555 | ||
| Acute Kidney Injury | 555 | ||
| Urinary Tract Infections | 556 | ||
| FRAILTY | 557 | ||
| GERIATRIC TRAUMA | 557 | ||
| Triage | 557 | ||
| Assessment | 557 | ||
| Treatment | 557 | ||
| SUMMARY | 558 | ||
| REFERENCES | 558 | ||
| Pain Management Issues for the Geriatric Surgical Patient | 563 | ||
| Key points | 563 | ||
| RISKS OF PAIN TREATMENT | 564 | ||
| MEASUREMENT OF PAIN | 565 | ||
| PHYSIOLOGIC CHANGES IN THE OLDER ADULT | 565 | ||
| OPIOID METABOLISM | 565 | ||
| INITIATING TREATMENT | 567 | ||
| OPIOIDS | 568 | ||
| CHRONIC PAIN AND OPIOIDS IN THE GERIATRIC PATIENT | 569 | ||
| MULTIMODAL ANALGESIA | 569 | ||
| NONOPIOID ADJUVANTS | 569 | ||
| Acetaminophen | 569 | ||
| Nonsteroidal Anti-Inflammatory Drugs | 570 | ||
| Tramadol | 570 | ||
| Gabapentinoids | 571 | ||
| WHAT NOT TO USE: THE BEERS CRITERIA | 571 | ||
| REGIONAL ANALGESIC TECHNIQUES | 571 | ||
| Perineural Blocks | 571 | ||
| Neuraxial Techniques | 574 | ||
| SUMMARY | 574 | ||
| REFERENCES | 574 | ||
| Chronic Pain in Older Adults | 577 | ||
| Key points | 577 | ||
| INTRODUCTION | 577 | ||
| AGE-RELATED DIFFERENCES RELEVANT TO PAIN | 578 | ||
| PAIN ASSESSMENT IN OLDER ADULTS | 581 | ||
| PAIN MANAGEMENT IN OLDER ADULTS | 582 | ||
| SUMMARY | 587 | ||
| REFERENCES | 587 | ||
| Palliative Care for the Geriatric Anesthesiologist | 591 | ||
| Key points | 591 | ||
| INTRODUCTION | 591 | ||
| PALLIATIVE CARE | 593 | ||
| END-OF-LIFE CARE AND HOSPICE | 595 | ||
| PALLIATIVE CARE–RELATED PERIOPERATIVE ISSUES | 595 | ||
| Cardiopulmonary Resuscitation/Do-Not-Resuscitate Orders/Anesthesiology | 595 | ||
| Noninvasive Ventilation | 597 | ||
| Hydration and Artificial Nutrition | 597 | ||
| ONGOING CONTROVERSIES IN PALLIATIVE MEDICINE | 597 | ||
| Palliative Sedation, Physician-Assisted Suicide, and Euthanasia | 597 | ||
| INTEGRATING PALLIATIVE CARE AND PERIOPERATIVE CARE FOR OLDER ADULTS | 598 | ||
| Palliative Care and the Surgical Intensive Care Unit | 598 | ||
| Palliative Care Consultation and Mechanical Circulatory Support Devices | 599 | ||
| SUMMARY | 601 | ||
| REFERENCES | 601 | ||
| Index | 607 |