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48 Cards in this Set

  • Front
  • Back
Reduction in CI is from
less requirement, not degeneration. Contractility not changed until 8th decade.
does he heart atrophy with age?
The heart does not atrophy with age.
Aging reduces the _______ and _________ responses to adrenergic stimulation and beta=agonists.
Aging reduces the inotropic and chronotropic responses to adrenergic stimulation and beta=agonists. Less EF enhancement under stress.
The stiffer ventricle and atrium do not undergo complete relaxation until
relatively late in diastole and passive ventricular filling, which occurs during early diastole, is significantly reduced.
Progressive change in _______ function, dependent of synchronous function.
distolic
Small decreases in _______ (PPV, hemorrhage, vasodilators) may significantly compromise SV.
venous return
Systolic HTN with increased arterial pulse pressure is a major CV risk factor; caused by
increased large artery stiffness d/t fibrotic replacement of elastic tissue. Reduces the ability of the aorta and large arteries to store hydraulic energy and increased vascular impedance to ejection of stroke volume. Leads to a prgressive and sustained rise in LV wall tension and workload that produces symmetric ventricular hypertriophy.
"Ringing" charachteristic of radial artery waveform in geriatric partients from
incresed vascular stiffness and loss of arterial cross-sectional area that cause increased reflection of radial artery waveform.
Age related loss of elasticity occurs in the lungs and CV system; an increase in fibrous connective tissue in lung parenchyma and
degeneration/cross-linking of lung elastin.
All elderly patients eventually demonstrate some degree of emphysema-like increases in
lung compliance, but calcification and stiffening of costrochondral joints reduce CW compliance so net pulmonary compliance is essentially unchanged. Nevertheless, loss of lung elastic recoil is the primary anatomic mechanism by which aging exerts deleterious effects on pulmonary gas exchange.
Breakdown of alveolar septae also reduces total alveolar surface area, increasing both
anatomic and alveolar dead space. This causes increased shunting and dead space.
Closing capacity/volume
increases. Small airways patency is compromised.
VC is
compromised because RV increases at the expense of IRV and ERV.
Skeletal calcification and increased airway resistance
increase work of breathing and predispose geriatric patients to postoperative ventilatory failure.
CV and ventilatory response to hypoxia or hypercarbia is
delayed in onset and is smaller.
Opioid induced CW rigidity occurs more
frequently.
Hepatic enzyme function is
unchanged but liver tissue mass declines 40% by 80 years and hepatic blood flow is proportionally reduced.
Loss of hepatic tissue mass largely explains the reduced
rates of plasma clearance and prolonged clinical effects of narcotics.
1/3 of renal mass lost by 80 years. RBF decreases by
10% per decade in early adulthood, especially in renal cortex, although the loss is masked by diffuse interstitial fibrosis and increase in intra-renal fat. 1/3 of glomeruli and tubular structures disappear and sclerosis impairs filtration by producing diverticula and impairing arteriole continuity.
Serum creatinine remains normal because of
loss of skeletal muscle mass
Geriatric patients do not require a unique fluid replacement protocol, but do
have a lower functional reserve.
Diminished thirst, poor diet and diuretic agent use for tx of HYN predispose debilitated elderly to
intracellular dehydration.
Decreased immune responsiveness, decreased B and T-cell activity, immunoglobulin E. Elderly are predisposed to
strep pneumonia, meningitis and septicemia. Sepsis is 2nd to respiratory failure in M/M with trauma.
Changes in body composition reduce basal metabolic requirements
by 10-15%. Impaired thermoregulatory vasoconstriction. 2x faster loss of heat.
glucose
Impaired of ability to handle glucose challenge, even though insulin release/timing is normal. Impairment of insulin function or tissue sensitivity.
Men lose 10-15 of TBW from
adipose gain and muscle loss..limited to intracellular compartment.
Plasma volume, red cell mass and ECF volumes
remain unchanged.
Decreased circulating blood volume are typically only in
bedridden or those with essential HTN.
Brain mass decrease

The most active, specialized neurons suffer the most.
20% by 80 years (mostly grey matter/neruons. glial unchanged) CSF volume increases to offset. (low-pressure hydrocephalus).
Decreased CBF is a consequence of
atrophy, not a cause. BBB remains intact.
Aging does not impair autoregulation of
cerebrovascular resistance and the vasoconstrictor response to hyperventilation remains intact.
Crystallized intelligence (language, personality) d
o not decline with increasing age.
PNS threshold intensities for perceptions
increase.
Reduced peripheral motor nerve conduction velocity and impairment of efferent corticospinal transmission
increases the latency between intention of onset of motor activity.
Neurogenic skeletal muscle atrophy causes
20-50% decreases in strength and steadiness.
Adrenal tissues atrophy and cortisol secretion declines at least
10% by age 80, although plasma %'s of nor-epi are 2-4x higher, this is offset by age-related depression of beta-adrenergic end organ responsiveness. (an endogenous beta-blockade)
There is ______ change in alpha or muscarinic cholinergic activity.
little
The autonomic reflex responses that maintain CV and metabolic hemostasis are progressively
impaired, evidenced by hypotension after induction.
The autonomic nervous system is
under-damped and is characterized by wider variation from baseline.
IV Morphine requirements are
inversely related to age and a higher block is achieved with the same LA dose. Segmental dose requirements are reduced.
MAC values
decline as much as 30% d/t increased sensitivity.
inter-compartmental transfer of drugs.
Delayed
NMB ED50
unchanged or increased. Duration prolonged.
_____ largely determines M and M. Outcomes r/t prior functional level.
Age-related disease, not aging itself
"best' single anesthetic technique.
none
Use depth of anesthesia required to prevent awareness only, higher increases
M/M.
Full recovery of psychomotor function _____
delayed.
Psychometric disruption
in 10-15% of patients remains after 3 months.