ycle of Aging
INCREASED PROBABILITY OF DEATH
III.Cardiopulmonary Function
A. 1. CARDIAC FUNCTION The demand for cardiopulmonary patients by daily exercise. function is maintained in elderly
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2.
Short-term increases in cardiac output are accomplished in the elderly patient initially by modest increases in heart rate and then by progressively larger stroke volume. 3. Aging decreases the inotropic and chronotropic responses to neurally mediated adrenergic stimulation such that maximum heart rate and inotropic response are age limited. 4. Passive ventricular filling, which normally occurs during the early phase of diastole, is decreased in elderly patients (stiffer and less compliant ventricle) 5. Age-related diastolic dysfunction elderly patients more dependent on synchronous atrial contraction for complete ventricular filling. a. VR stroke volume compromise b. Perioperative arterial hypotension is predictable more common in elderly than in young 6. Systolic arterial hypertension fibrotic replacement of elastic tissue within the cardivascular system. B. REPIRATORY FUNCTION Fibrous connective tissue loss of lung elastic recoil (inevitable emphysema-like changes) 1. FRC , VC , Residual Volume 2. Costochondral calcification thorax more rigid WoB 3. Age related acute post-operative ventilatory failure 4. Age related decrease in arterial oxygenation 5. More vulnerable to developing transient apnea when given drug (opioid, benzodiazepin) post operative. 6. The treshold stimulus needed for vocal cord closure risk of aspiration of gastric content.
IV.
A .
B . C .
1.
Renal tissue mass decrease by about 30%, and RBF decreases by about 50% by the eighth decade of life. 2. Serum creatinine concentration usually remains within the normal range. 3. Intravascular and intracellular dehydration 1. Elderly patients exhibit decreased immune responsiveness
kg 80706050403020100 -
MEN WOMEN
BODY LI PI D LIPI OTHER TISSUE
kg - 80 - 70 - 60 - 50 - 40 - 30 - 20 - 10 -0
BODY WATER
YOUNG OLDER
YOUNG OLDER
Age related changes in body composition are gender specific. I ncreases ncreases in body fat offset bone loss and intracellular dehydration in women, whereas in man accelerated loss of skeletal skeletal muscle muscle and and other component of lean lean tissue mass produces contraction of intracellular water and a decrease in total total body weight.
HasanulHasanul-2003
Hand book of Clinical Anesthesia: Barash.PG, , Cullen.BF, Barash.PG Cullen.BF, Stoelting.RK :2001, 654
Age related changes in body composition are gender specific. Increases in body fat offset bone loss and intracellular dehydration in women, whereas in man accelerated loss of skeletal muscle and other component of lean tissue mass produces contraction of intracellular water and a decrease in total body weight. KAN-182 Mira Yulianti (01-107)
1.
BMR , heat production , special risk for intraoperative hypothermia Intraoperative decreases in core body temperature average almost 10C per hour. The time needed for postoperative spontaneous rewarming may be prolonged. 2. Progressive impairment of the ability to handle an intravenous glucose challenge B. Plasma volume, red cell mass, and ECF volumes are normally well maintained in normotensive elderly individuals who maintain their habits of daily physical activity Increases in total body lipid content enlarge the volume of distribution of drugs (inhaled anesthetics, barbiturates, benzodiazepin). This may delay recovery in elderly patients .
C.
VI.
A. B.
Aging decreases brain size, and neurons that synthesize neurotransmitters (dopamine, norepinephrine, tyrosine, serotonin) seem to be most affected. CBF decreases in proportion to decreased brain tissue. 1. Autoregulation is well maintained, and the cerebral vasoconstrictor response to hyperventilation remains intact. 2. In the absence of cerebrovascular disease, the conventional guidelines for controlled hypotension during neurosurgical procedures are appropriate for elderly.
C. Comprehension and long term memory are well maintained. D. Hypothalamic-pituitary-adrenal levels. dysregulation and increased plasma cortisol
VII.
A.
The treshold intensities of stimuli needed to initiate all forms perception are increased. B. Aging is associated with a gradual but significant deterioration electrical conduction along efferent motor pathway. C. Cholinoreceptors at the skeletal muscle .
B.
C. ANS underdamped delayed restabilization during hemodynamic stress. General anesthesia, spinal, epidural anesthesia (pharmacologic sympathectomy) systemic hypotension that is more severe compared with young adult.
IX.
A.
There are decreased segmental dose requirement for local anesthetics during epidural, and slightly higher levels of sensory blockade undergoing spinal anesthesia B. MAC decrease predictably with increasing age. C. Systemic morphine requirements are inversely related to patient age. KAN-182 Mira Yulianti (01-107)
D. Barbiturates, and benzodiazepines are less consistent than those for inhaled anesthetics E. Doses of muscle relaxants and steady state plasma concentrations required to produce a given degree of neuromuscular blockade are not changed by aging. The clinical duration of action is prolonged if the elimination of the muscle relaxant is dependent on hepatic or renal clearance mechanisms
DOXACURI UM DOXACURIUM PI PECURONI UM METOCURI NE CURARE PANCURONI UM CI SATRACURIUM VECURONI UM ATRACURI UM ROCURONI UM MI MI VACURI UM UM
I 0 I 20 I 40 I 60 I 80 I 100 I 120
RI : Recovery I ndex , the time required for spontaneous recovery from 25% to 75% of the control evoked neuromuscular response.
HasanulHasanul-2003
Hand book of Clinical Anesthesia: Barash.PG, Barash.PG, Cullen.BF, Cullen.BF, Stoelting.RK :2001, 658
RI : Recovery Index , The time required for spontaneous recovery from 25% to 75% of the control evoked neuromuscular response
C. The choice of anesthetic drug or technique does not seem to influence the overall outcome in elderly patients 1. Newer intravenous drugs (remifentanil, cisatracurium) minimize dependence on organ system functional reserve, whereas newer inhaled anesthetics (sevoflurane, desflurane) provide rapid recovery of consciousness even in elderly patients 2. Prompt and complete postoperative recovery of mental function is particularly important in elderly Less likely to experience nausea and vomiting, but more likely to experience mental confusion following outpatient surgery compared with young adults. The most common cause of failure to emerge promptly from anesthesia is too much anesthesia or too many anesthetic drugs. KAN-182 Mira Yulianti (01-107)
Nerve palsies due to regional anesthesia seem to occur more often compared
with younger adults
D.
Anesthetic management is appropriate, surgical convalescence uncomplicated, full return of cognitive function to preoperative levels may require 5-10 days Physical management in OT & RR, require special precautions, gentle and careful positioning Postoperative bleeding & bacterial infection more likely compared with adults Diastolic dysfunction, ventricular stiffness, rate of iv.fluid (too may precipitate pulmonary edema Untreated pain & related emotional stress immune responsiveness
E.
F young . fast)
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