Problems With Geriatric Anesthesia Patients

This issue of Anesthesiology Clinics prepares the anesthesiologist for the most challenging problems he will face with geriatric patients. Topics covered include delirium, postoperative cognitive dysfunction, fat embolism during hip replacement, Parkinson's disease and deep brain stimulator placement, diastolic dysfunction, atrial fibrillation, delayed arousal, severe atrial stenosis, multiple medications, informed consent and the ethical management of the older patient, dead bowel, acute perioperative beta-blockade in the older patient, urinary retention, and anesthetic care for patients with skin breakdown.

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.

This issue of Anesthesiology Clinics, edited by Dr. Elizabeth Whitlock and Dr. Robert Whittington, in collaboration with Consulting Editor Lee Fleisher, focuses on Geriatric Anesthesia. Topics in this issue include: The Growing Challenge of the Elderly Population; The Perioperative Period; Preoperative Assessment of the Geriatric Patient; Prehabilitation: Optimizing Elders Undergoing Elective Surgery; The Ethics of Surgery at the End of the Life; Perioperative Geriatric Physiology and the Frailty Syndrome; Geriatric Pharmacology; Emergency Surgery in the Elderly; Management of Acute Pain in the Elderly; Special Considerations for the Elderly Brain: Delirium and Perioperative Cognitive Change; Special Challenges of the Geriatric Critical Care Patient; Chronic Pain Management in the Elderly; Providing Patient- Focused Care: Treatment Burdens, Difficult Conversations, and Symptom Management; and Future Directions for Geriatric Anesthesiology.

The Manual of Geriatric Anesthesia is a practical guide for physicians, residents, and students interested in the care of the elderly patient undergoing surgery. Although primarily written for anesthesiologists, other perioperative physicians and nurses will also find the information highly valuable. Highlights of the text include concise and clear discussions of preoperative assessment, anesthetic administration, the immediate postoperative care, as well as the more classic ‘geriatric’ topics such as the hip fracture patient, cataract surgery, postoperative delirium, dementia, ethics and end of life care. Clinical geriatric principles are woven into the text so that the reader can develop skills in geriatrics and develop a broader understanding of terminology and principles used in geriatric medicine.

Delivers a detailed overview of both the basic science and practical, day-to-day clinical issues related to the administration of anesthesia in geriatric patients. It begins with a look at the demographics and economic issues surrounding surgery and anesthesia in the elderly, plus the effects of aging on organ reserve. It then considers geriatric anesthetic implications across the full spectrum of organ systems-from the central/peripheral nervous system to the urinary/hepatic systems.

Surgical and anesthetic techniques have evolved to allow a growing number of older adults to undergo surgery, and current estimates are that 50% of Americans over the age of 65 years old will have an operation. However, as the knowledge regarding perioperative care of the elderly surgical patient grows, so do the questions. In this edition, each chapter includes a section entitled “Gaps in Our Knowledge,” meant to highlight areas in which research is needed, as well as hopefully inspire readers to begin solving some of these questions themselves. Building upon the strong foundation of the first two editions, Geriatric Anesthesiology, 3rd edition also assembles the most up-to-date information in geriatric anesthesia and provides anesthesiologists with important new developments.Topics covered include several new chapters that reflect the evolution of multidisciplinary geriatric care throughout the perioperative continuum, as well as the growing body of literature related to prehabilitation. In addition, discussion of the surgeon’s perspective and geriatrician’s perspective on surgery in the geriatric population is covered, as well as the systematic physiologic changes associated with aging and the pharmacologic considerations for the geriatric patient undergoing procedures. Finally, the last section discusses postoperative care specific to the geriatric population, including acute pain management, ICU management, recent evidence and up-to-date practice regarding delirium and postoperative cognitive dysfunction, and palliative care.

Geriatric Anesthesia: A Practical Guide is a comprehensive reference on geriatric anesthesia. The book is divided into three sections. The first section covers the basics of both anatomical and physiological changes in senescence, and important polypharmacy considerations common in elderly patients. The next section covers anesthesia for cardiac and non-surgical patients. Various controversies and legal ethical issues that are particularly significant in the elderly such as advance directives, code status discussions, specific patient groups and shared decision-making prior to surgical interventions, are covered in the final section. Key features - 20 referenced chapters covering basic geriatric anesthesia considerations, cardiac and non-surgical patients and special topics, respectively - Contributions and references from experienced anesthesiologists - Emphasis on tailoring perioperative management depending on specific circumstances of patients - Addresses novel and commonly overlooked topics related to the geriatric population This book is a guide for both anesthesia providers and non-anesthesia medical providers, trainees and students. It equips them with necessary information to understand and devise anesthetic plans while being aware of postoperative complications and the respective treatment and management options.

Global ageing, in both developed and undeveloped countries, has made the need for high-quality knowledge and research on anaesthesia for the elderly increasingly important. The second edition of Anaesthesia for the Elderly Patient offers the anaesthetist guidance on the evaluation and management of elderly patients that present at hospital for surgery and anaesthesia. Containing 15 chapters on key topics such as emergency anaesthesia, orthopaedic surgery, and neurosurgery, as well as a new chapter on 'Anaesthesia for Non-Theatre Environments', this book ensures the reader is fully prepared for the clinical challenges they may face when working with this ever-growing vulnerable group. Part of the Oxford Anaesthesia Library series, this second edition of Anaesthesia for the Elderly Patient offers a fully up-to-date comprehensive introduction to the major clinical issues facing anaesthetists working with elderly patients. All chapters are fully updated and content is presented in a concise and easy to read format, with helpful key points listed at the start of each chapter.