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Anesthesia Issues in Geriatrics

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Anesthesiology

Abstract

The elderly, above 65 years, is the fastest growing segment of the population in the United States and European Union as a result of advances in health care. A large percentage of this population will require anesthesia for surgical, diagnostic and interventional procedures either in elective or emergency settings. Although anesthesia and surgical techniques have improved significantly, anesthesia related morbidity and mortality is still high in this vulnerable population. This is more likely due to age related disease and not the age itself. The functional reserve of each organ system begins to decline with age, and may not be clinically apparent until the organ system is subjected to increased demand, in terms of peri-operative stress, disease, polymedications including anticoagulants or surgical interventions. Aging limits the physiological reserve of the cardiovascular, neurologic, respiratory, endocrine, hepatic and renal systems and may influence the pharmacokinetics and pharmacodynamics of anesthetic agents, resulting in prolonged action and increased risk of post-operative complications. The co-morbidities may co-exist with malnutrition, communication difficulties, psycho-social alterations, disability, dementia and frailty. The traditional pre-anesthetic assessment captures limited information hence paving way for the more informative comprehensive geriatric assessment (CGA) which assesses the functional status and frailty. CGA is an established evaluation methodology for evaluating and optimizing physical, psychological, functional and social issues in older patients so as to improve long term outcomes. The most devastating post-operative complications following surgery is that due to changes in cognition as the elderly may suffer from delirium, dementia or post-operative cognitive dysfunction which impact memory, planning, organisation, attention and may result in loss of independence and quality of life.

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Authors and Affiliations

  1. Department of Anesthesiology, Critical Care and Pain Medicine, JSS Medical College, Mysore, India

    Nalini Kotekar

  2. Department of Anesthesiology and Critical Care, A.J. Medical College and Research Centre, Mangalore, India

    Anshul Shenkar M.B.B.S.

  3. Department of Anesthesiology, Critical Care and Pain Medicine, JSS Medical College and Hospital, Mysore, India

    Adarsh A. Hegde M.B.B.S.

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  1. Nalini Kotekar
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  2. Anshul Shenkar M.B.B.S.
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Editor information

Editors and Affiliations

  1. Hospital University Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA

    Basavana G. Goudra

  2. Department of Anesthesiology, Emory University, Atlanta, Georgia, USA

    Michael Duggan

  3. Department of Anesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Vidya Chidambaran

  4. University Hospitals Birmingham, Birmingham, United Kingdom

    Hari Prasad Krovvidi Venkata

  5. Emory University Hospital, Atlanta, Georgia, USA

    Elizabeth Duggan

  6. University of Alabama at Birmingham, Birmingham, Alabama, USA

    Mark Powell

  7. All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi, India

    Preet Mohinder Singh

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Kotekar, N., Shenkar, A., Hegde, A.A. (2018). Anesthesia Issues in Geriatrics. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_80

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