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25 Cards in this Set
- Front
- Back
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What happens to baseline functionof organ systems with age?
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Progressively declines, resulting in a decreased physiologic ability to handle stress.
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What has more impact on morbidity and mortality in the geriatric population, coexisting disease, or age alone?
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Coexisting disease.
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Five things that play a role in the physiology of perioperative cardiovascular complications?
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Stiff ventricle, impaired diastolic filling, increased PVR, fibrosis/fatty myocardial infiltration, conduction problems.
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Why is estimation of cardiac reserve difficult?
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Most elderly patients with cardiac dysfunction will only show signs when stressed.
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Six risk factors in revised cardiac risk index?
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High-risk surgery (intraperitoneal, intrathoracic, aortic). Ischemic heart disease. History of heart failure. History of cerebrovascular disease. Insulin therapy for diabetes. Creatinine greater than 2.0 mg/dl.
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Cardiac event rates for 1, 2, and 3 risk factors?
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1=0.9%, 2=7%, 3=11%
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Three prevention strategies for perioperative cardiovascular complications?
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revascularization, beta blockers, statins.
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When should revascularization be considered in prevention of perioperative cardiovascular complications?
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Controversial. Consider only if surgery can be delayed for several months or another indication exists.
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Describe use of beta blockers in prevention of perioperative cardiovascular complication?
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Controversial. May increase mortality. Do not start in hospital unless treating an unstable coronary syndrome.
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Whould statins be held perioperatively?
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No, acute discontinuation can worsen outcomes.
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What is one problem with postop use of statins?
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Caution in patients at risk for delirium, as data suggests increased risk of postop delirium in statin users (OR 1.3).
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Four factors in physiology of perioperative pulmonary complications?
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Loss of elastic recoil. Impaired chest wall movement (decreased VC, FEV1). Loss of alveoli (decreased gas exchange). Decreased cough/ciliary function.
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What lowers an elderly patient's complication rate from 42-9%, mortality from 13-1%?
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Exercise capacity of 2 min. with HR of 99 BPM.
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Five effects of splinting from poor pain control post--op?
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Restircts lung expansion. Limits cough secretions. Increases risk for atelectasis, pneumonia, hypoxia.
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Six risk factors for aspiration pneumonia?
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Acute/chronic cognitive dysfunction, dysphagia, GERD, CVA/Parkinson's disease, dementia, low albumin.
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Six things that can be done to prevent aspiration pneumonia?
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Appropriate diet, HOB elevation, upright eating, oral hygiene (rinses), dentures, lung expansion maneuvers.
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What are four factors in physiology of perioperative renal considerations?
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Decreased: renal plasma flow, GFR, creatinine clearance, renal mass.
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Three renal things that elderly patients are more susceptible to?
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Volume overload. Prolonged sedative effects. Drug-induced acute renal failure with NSAIDs, diuretics, antibiotics.
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What is the most sensitive marker of renal function in the elderly? What should you not rely in?
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Calculated creatinine clearance is the most sensitive marker of renal function in the elderly (DO NOT RELY ON CREATININE ALONE).
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Seven risk factors associated with poor nutritional status?
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Low weight, poverty, alcohol abuse, declining physical/cognitive function, recent hospitalization or surgery, change in the number or type of medications, micturation dysfunction.
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How is low preop albumin correlated with mortality?
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<1% with albumin >4.6 g/dL to 29% mortality with albumin < 2.1 g/dL
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how do pain medication requirements in the elderly compar to younger patients?
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Pain medications requirements in the elderly are initially similar to younger patients, but decrease more rapidly 1-2 days later.
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Five things to prevent delirium post-operatively?
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Orientation to surroundings. Sleep protocol. Early mobility. Visual/hearing protocol. Monitor for dehydration.
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Three things to emphasize in careful consideration of risks and benefits of surgery in the elderly:
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Age alone is not a contraindication to surgery. patient/family education of the specific risks involved based on age and comorbidities, and the expected needs for recovery and rehabilitation in the post-operative period (rehab, SNF, home health, etc.). Consider palliative care evaluation if there are any uncertainties regarding the patient's goals of care.
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11 risk factors on Arozullah respiratory failure index?
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AAA repair. Thoracic surgery. Neurosurgery/upper abdominal/peripheral vascular. Neck surgery. Emergency surgery. Albumin <3.0 g/dl. BUN>30 mg/dl. Paritally or fully dependent functional status. History of COPD. Age >/= 70. Age60-69. READ THE NUMBERS ON THE CHART.
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