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The Aging Respiratory System: Strategies to Minimize Postoperative Pulmonary Complications

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Geriatric Anesthesiology

Abstract

Even though there is a gradual reduction in respiratory function that occurs with age, respiratory capacity remains adequate for healthy elderly individuals under normal circumstances. However, this reduced capacity can be unmasked and lead to morbidity when elderly patients are under times of stress. The perioperative period disrupts normal respiratory physiology via multiple mechanisms including exposure to anesthetic agents which reduce respiratory drive and weakened musculature required for respiration, altered body position leading to atelectasis, and changes in lung fluid balance. With their reduced capacity, elderly patients are particularly susceptible to postoperative pulmonary complications, which account for approximately 40% of the perioperative deaths in patients over 65 years of age. In this chapter, we review the effects of aging on pulmonary function and the effects of anesthesia and surgery on this function. Particular emphasis is directed to the surgical and anesthetic factors that stress the respiratory system of the elderly and how these factors increase the risk of postoperative pulmonary complications.

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Acknowledgments

This chapter is dedicated to our great teachers, the late Drs. Joseph Rodarte and Robert Hyatt, who embedded in us a passion for pulmonary physiology and medical research in general. – Juraj Sprung and David O. Warner

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Authors and Affiliations

  1. Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA

    Ana Fernandez-Bustamante

  2. Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA

    Juraj Sprung, Toby N. Weingarten & David O. Warner

  3. Department of Anesthesiology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA

    Rodrigo Cartin-Ceba

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  1. Ana Fernandez-Bustamante
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  2. Juraj Sprung
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  3. Rodrigo Cartin-Ceba
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  4. Toby N. Weingarten
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  5. David O. Warner
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Corresponding author

Correspondence to Juraj Sprung .

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Editors and Affiliations

  1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

    J. G. Reves

  2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Sheila Ryan Barnett

  3. Department of Anesthesia and Perioperative Medicine, Department of Anesthesiology, Medical University of South Carolina, Charleston, South Carolina, USA

    Julie R. McSwain

  4. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA

    G. Alec Rooke

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Fernandez-Bustamante, A., Sprung, J., Cartin-Ceba, R., Weingarten, T.N., Warner, D.O. (2018). The Aging Respiratory System: Strategies to Minimize Postoperative Pulmonary Complications. In: Reves, J., Barnett, S., McSwain, J., Rooke, G. (eds) Geriatric Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-66878-9_12

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