Intraoperative Problems and Management in Geriatric Trauma Patients
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 6, Issue 5
Abstract
Modern society is characterized as having an ever-enlarging population of older adults. There are more elderly patients, and the average age of this group is increasing. The anaesthetic management of surgery for the elderly trauma victim is more complicated than in younger adults. Evaluation of the physiologic status of the geriatric patient should take into account the variability of the changes associated with advancing age. Care of the injured elderly patient requires thorough preoperative assessment and planning and the involvement of a multidisciplinary clinical team knowledgeable about and interested in the management of the elderly surgical patient. Traumatic injury is the four most cause of mortality in elderly patients. At the end of the last century 20 % of injuries occurred in the elderly population. These patients respond differently to trauma, recover more slowly and have higher morbidity and mortality. It is not clear if these differences are due to increased comorbidity or decreased physiologic reserve [1,2]. After traumatic injury, it is important that all interventions be evidence based. There are few prospected randomized trials that focus on elderly issues. There is no uniform definition of the term elderly. Historically, the term elderly was applied to individuals over 65 years of age. However, aging is now viewed as a physiologic continuum rather than chronologic age. Nowadays we divide geriatric population into young old - 65-80 years and oldest old- over 80 years [1]. Aging is a universal and progressive physiologic phenomenon characterized by degenerative changes in both the structure and the functional reserve of organs and tissues. Aging is a consequence of free radicals damage within mitochondrial DNA (oxidative stress) [3]. Elderly patients (arbitrarily defined as being over 65 years of age) are vulnerable to the adverse effects of anaesthesia. With advancing age, the autonomic nervous system, heart and blood vessels become less capable of maintaining hemodynamic stability. Increased arterial rigidity and increased sympathetic nervous system activity contribute to the increase in systemic vascular resistance. Increased stiffness of the hypertrophied elderly cardiac ventricle leads to increased end-diastolic pressure with severe diastolic dysfunction. With advancing age, parasympathetic activity decreases while sympathetic neural activity increases. Elderly subjects manifest a reduced responsiveness to beta-adrenergic stimulation and reduced baroreceptor reflex [4]. Changes in the respiratory system with age comprise: decline in compliance of bony thorax, loss of respiratory muscle mass, decrease in alveolar gas exchange surface and decrease in central system responsiveness. Aged lungs have some features of chronic obstructive lung disease, increased residual volume, reduced vital capacity and FEV1 [5]. The target organ for all anesthetic agents is the central nervous system. Aging produces a decrease neural density and loss of 30% brain mass at the age of 80 years (mostly grey matter). Signs of peripheral nervous system aging are marked by a loss of motor, sensory and autonomic fibers and decrease in conduction velocity. Aging decreases functional capacity of other organ system such as hepatic, renal and endocrine system. Administration of drug in the elderly compared to young subjects results in higher blood levels, due to a smaller volume of distribution and due to a slower drug metabolism. The brain is more sensitive to the drug in the elderly and all these effects conspire to increase the length of time that drug is active in the elderly patient [5].
Authors and Affiliations
Iztok Potocnik, Vesna Novak Jankovic
Keywords
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- EP ID EP585827
- DOI 10.26717/BJSTR.2018.06.001413
- Views 140
- Downloads 0
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