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GERTRUDE SIYAKA
Consultant Anaesthesiologist
Steve Biko Academic
Hospital
Introduction
Normal physiological changes
associated with ageing
Pharmacokinetics and
pharmacodynamics in the elderly
Pre-operative assessment
Day case surgery
Anaesthesia for orthopaedic surgery
Post operative complications
References
1. Cardiovascular system
Main contributor for adverse outcome
in peri-operative period
Heart
LV hypertrophy frequently evolves and
related to elevated SVR
Cardiac mass increases- concentric
hypertrophy
Interstitial fibrosis in myocardium leads
to poor contractility
Vasculature
Arteriosclerosis is the hallmark feature
Contributing factors are: hypertension
,hypercholesterolemia, oxidative stress
and genetic disposition
Arteriosclerosis an irreversible process
CEA and AAA repair most frequently
performed procedures in elderly
Adrenergic sensitivity
Plasma CATS levels after stimuli not
been shown to diminish
Blunted B-receptor responsiveness
possibly due to down regulation and
decreased agonist binding to receptor
Increase in vigil tone
There is 20% loss of HR response
during exercise in 75 yr old compared
to 25 yr old
2. Respiratory system
Typical barrel chest appearance results in
increased work of breathing and reduced
compliance
Loss of elastic recoil within the lung and changes
in surfactant production leads to limited maximal
expiratory flow
Lung volumes: increase in RV, closing capacity,
FRC , TLC (minimal). Decrease in VC
Flow :progressive decrease in FEV1 /FVC
Oxygenation: decrease efficiency in alveolar gas
exchange resulting in PaO2and increase alveolar
arterial gradient
Impaired response to hypoxia, hypercarbia and
mechanical stress
3.Renal
Renal mass decreases by 30% by age
80
Renal blood flow and creatinine
clearance decrease
Poor electrolyte handling and capacity
to concentrate or dilute urine
Excretion of some anaesthetic agents
is impaired
4. Nervous system
Brain weight declines by 10%
Cerebral atrophy common
Cerebral blood supply reduced and
vertebrobasilar insufficiency common
Gradual decline in cognitive function,
memory and reasoning performance
Confusion common
Altered sleep pattern
Thermoregulation: poor response to
hypothermia
NO MAGIC BULLETS
Effects of initial dose on single
patient highly variable
Smaller doses compared to younger
patients
Low threshold for invasive monitoring
Position carefully to avoid pressure
and nerve injuries
Avoid hypothermia
ADVANTAGES
DISADVANTAGES
GA may be needed
Same drugs used but consideration
to dosing the elderly
LMA can safely be used but proviso
Manage pain adequately
Consider prophylaxis for PONV
Available on request