Skip to main content
SpringerLink
Log in
Book cover

Anesthesia for Trauma pp 369–380Cite as

Anesthesia for the Geriatric Trauma Patient

  • Chapter
  • First Online:

  • 2226 Accesses

Abstract

As healthcare continues to improve, the average life expectancy is increasing and hospitals are seeing a steady rise in the average age of their trauma patients. The elderly have unique physiology, pharmacokinetics, and anesthetic concerns that differ from their younger counterparts. This chapter focuses on the impact of geriatric trauma in hospitals, initial triaging and assessment, special pharmacologic and physiologic considerations, the most common injuries, and current anesthetic management strategies.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Center for Disease Control and Prevention National Center for Health Statistics. Life expectancy. http://www.cdc.gov/nchs/fastats/lifexpec.htm. Accessed June 20, 2013.

  2. Federal Interagency Forum on Aging-Related Statistics. Older Americans 2010: key indicators of well-being. Washington, DC; 2010 July. http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/Docs/OA_2010.pdf

  3. Campbell JW, et al. In harm’s way: moving the older trauma patient toward a better outcome. Geriatrics. 2009;64(1):8–13.

    PubMed  Google Scholar 

  4. MacKenzie EJ, et al. Acute hospital costs of trauma in the United States: implications for regionalized systems of care. J Trauma. 1990;30(9):1096–101; discussion 101–3.

    Article  CAS  PubMed  Google Scholar 

  5. American College of Surgeons Committee on Trauma. Geriatric trauma. In: ATLS: student course manual. 8th edition. Chicago: ACLS; 2008. pp. 247–57.

    Google Scholar 

  6. The Eastern Association for the Surgery of Trauma. Geriatric trauma (update). http://www.east.org/resources/treatment-guidelines/geriatric-trauma. Accessed July 20, 2012.

  7. Carpenter CR, DesPain B, Keeling TN, et al. The Six-Item Screener and AD8 patients. Ann Emerg Med. 2011;57(6):653–61.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Labib N, Nouh T, Winocour S, et al. Severely injured geriatric population: morbidity, mortality and risk factors. J Trauma. 2011;71:1908–14.

    Article  PubMed  Google Scholar 

  9. Thompson HJ, McCormick WC, Kagan SH. Traumatic brain injury in older adults: epidemiology, outcomes, and future implications. J Am Geriatr Soc. 2006;54:1590–5.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Keller JM, Sciadini MF, Sincalir E, et al. Geriatric trauma: demographics, injuries and mortality. J Orthop Trauma. 2012;26(9):e161–5.

    Article  PubMed  Google Scholar 

  11. Ganz DA, Bao Y, Shekelle PE, et al. Will my patient fall? JAMA. 2007;297:77–86.

    Article  PubMed  Google Scholar 

  12. Roudsari BS, Ebel BE, Corso PS, et al. The acute medical care costs of fall-related injuries among the US older adults. Injury. 2005;36:1316–22.

    Article  PubMed  Google Scholar 

  13. Linn BS. Age differences in the severity and outcome of burns. J Am Geriatr Soc. 1980;28:118–23.

    CAS  PubMed  Google Scholar 

  14. Buckner RL. Memory and executive function in aging and AD: multiple factors that cause decline and reserve factors that compensate. Neuron. 2004;44:195–208.

    Article  CAS  PubMed  Google Scholar 

  15. Lewis MC, Karim A, Paniagua M. Geriatric trauma: special considerations in the anesthetic management of the injured elderly patient. Anesthesiol Clin. 2007;25:75–90.

    Article  PubMed  Google Scholar 

  16. Geokas MC, Lakatta EG, Makinodan T, et al. The aging process. Ann Intern Med. 1990;113:455466.

    Article  Google Scholar 

  17. Rooke GA. Autonomic and cardiovascular function in the geriatric patient. Anesthesiol Clin North America 2000;18:31,46, v-vi.

    Google Scholar 

  18. Raine JM, Bishop JM. A-a difference in O2 tension and physiologic dead space in normal man. J Appl Physiol. 1963;18:284.

    CAS  PubMed  Google Scholar 

  19. Varon A, Smith C, et al. Anesthetic management of geriatric trauma patient. In: Essentials of trauma anesthesia. Cambridge: Cambridge University Press; 2012. p. 275–87.

    Google Scholar 

  20. Muravchick S. Anesthesia for the elderly. In: Miller RM, editor. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000. p. 2140–5.

    Google Scholar 

  21. Small SA. Age-related memory decline: current concepts and future directions. Arch Neurol. 2001;58:360–4.

    Article  CAS  PubMed  Google Scholar 

  22. Peters A. Structural changes that occur during normal aging of primate cerebral hemispheres. Neurosci Biobehav Rev. 2002;26:733–41.

    Article  PubMed  Google Scholar 

  23. Shetty AK, Hattiangady B, Shetty GA. Stem/progenitor cell proliferation factors FGF-2, IGF-1, and VEGF exhibit early decline during the course of aging in the hippocampus: role of astrocytes. Glia. 2005;51:173–86.

    Article  PubMed  Google Scholar 

  24. Steiner LA. Postoperative delirium. Part 1: pathophysiology and risk factors. Eur J Anesthesiol. 2011;28(9):628–36.

    Article  CAS  Google Scholar 

  25. Franko J, Kish KJ, O’Connell BG, et al. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma. 2006;61:107–10.

    Article  CAS  PubMed  Google Scholar 

  26. Lavoie A, Ratte S, Clas D, et al. Preinjury warfarin use among elderly patients with closed head injuries in a trauma center. J Trauma. 2004;56:802–7.

    Article  PubMed  Google Scholar 

  27. Neideen T, Lam M, Brasel KJ. Preinjury beta blockers are associated with increased mortality in geriatric trauma patients. J Trauma. 2008;65:1016–20.

    Article  CAS  PubMed  Google Scholar 

  28. Lambert DA, Sattin RW. Death from falls, 1978-1984. MMWR CDC Surveill Summ. 1998;37:S21–6.

    Google Scholar 

  29. Finelli FC, Jonsson J, Champion HR, et al. A case control study for major trauma in geriatric patients. J Trauma. 1989;29:541–8.

    Article  CAS  PubMed  Google Scholar 

  30. Phillips S, Rond PC, Kelly SM, et al. The failure of triage criteria to identify geriatric patients with trauma: results from the Florida Trauma Triage Study. J Trauma. 1996;40:278–83.

    Article  CAS  PubMed  Google Scholar 

  31. Baker SP, O’Neill B, Haddon W, et al. The injury severity score: a method for describing patients with multiple injuries and valuating emergency care. J Trauma. 1974;14:187–96.

    Article  CAS  PubMed  Google Scholar 

  32. Lomoschitz FM, Blackmore CC, Mirza SK, et al. Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries. Am J Roentgenol. 2002;178:573–7.

    Article  CAS  Google Scholar 

  33. Arden JR, Holley FO, Stanski DR. Increased sensitivity to etomidate in the elderly: initial distribution versus altered brain response. Anesthesiology. 1986;65:9–27.

    Article  Google Scholar 

  34. Homer TD, Stanski DR. The effect of increasing age on thiopental disposition and anesthetic requirement. Anesthesiology. 1985;62:714–24.

    Article  CAS  PubMed  Google Scholar 

  35. Reves JG, Fragen RJ, Vinik HR, et al. Midazolam: pharmacology and uses. Anesthesiology. 1985;62:310–24.

    Article  CAS  PubMed  Google Scholar 

  36. Heffernan DS, Thakkar RK, Monaghan SF, et al. Normal presenting vital signs are unreliable in geriatric blunt trauma victims. J Trauma. 2010;69:813–20.

    Article  PubMed  Google Scholar 

  37. Martin J, Alkhoury F, O’Connor J, et al. ‘Normal’ vital signs belie occult hypoperfusion in geriatric trauma patients. Am Surg. 2010;76:65–9.

    PubMed  Google Scholar 

  38. Callaway DW, Shapiro NI, Donnino MW, et al. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009;66:1040–4.

    Article  CAS  PubMed  Google Scholar 

  39. Jacobs DG, Plaisier BR, Barie PS, et al. Practice management guidelines for geriatric trauma: the EAST practice management guidelines work group. J Trauma. 2003;54:391–416.

    Article  PubMed  Google Scholar 

  40. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642–7.

    Article  PubMed  Google Scholar 

  41. Santora TA, Schinco MA, Trooskin SZ. Management of TRAUMA in the elderly patient. Surg Clin North Am. 1994;74:163–85.

    CAS  PubMed  Google Scholar 

  42. Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br. 2005;87:1123–6.

    Article  CAS  PubMed  Google Scholar 

  43. Zuckerman JD, Skovron ML, Koval KJ, et al. Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg Am. 1995;77:1551–6.

    CAS  PubMed  Google Scholar 

  44. Sexson SB, Lehner JT. Factors affecting hip fracture mortality. J Orthop Trauma. 1987;1:298–305.

    Article  CAS  PubMed  Google Scholar 

  45. Vidan MT, Sanchez E, Gracia Y, et al. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med. 2011;155:226–33.

    Article  PubMed  Google Scholar 

  46. Koval KJ, Aharonoff GB, Rosenberg AD, et al. Functional outcome after hip fracture: effect of general versus regional anesthesia. Clin Orthop Relat Res. 1998;348:37–41.

    PubMed  Google Scholar 

  47. Gilbert TB, Hawkes WG, Hebel JR, et al. Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation of 741 elderly patients during 2-year follow-up. Am J Orthop. 2000;29:25–35.

    CAS  PubMed  Google Scholar 

  48. Valentin N, Lomholt B, Jensen JS, et al. Spinal or general anesthesia for surgery of the fractured hip? A prospective study of mortality in 578 patients. Br J Anaesth. 1986;58:284–91.

    Article  CAS  PubMed  Google Scholar 

  49. Neuman MD, Silber JH, Elkassabany NM, et al. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology. 2012;117:72–92.

    Article  CAS  PubMed  Google Scholar 

  50. Pentland B, Hutton LS, Jones PA. Late mortality after head injury. J Neurol Neurosurg Psychiatry. 2005;76:395–400.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  51. Tornetta III P, Mostafavi H, Riina J, et al. Morbidity and mortality in elderly trauma patients. J Trauma. 1999;46:702–6.

    Article  PubMed  Google Scholar 

  52. Utomo WK, Gabbe BJ, Simpson PM, et al. Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury. Injury. 2011;40:973–7.

    Article  Google Scholar 

  53. Irvine DH, Foster JB, Newell DJ. Prevalence of cervical spondylosis in a general practice. Lancet. 1965;22(14):1089–92.

    Article  Google Scholar 

  54. Donaldson 3rd WF, Towers JD, Doctor A, et al. A methodology to evaluate motion of the unstable spine during intubation techniques. Spine. 1993;18:2020–3.

    Article  PubMed  Google Scholar 

  55. Unni VK, Johnston RA, Young HS, et al. Prevention of intracranial hypertension during laryngoscopy and endotracheal intubation. Br J Anaesth. 1984;56:1219–23.

    Article  CAS  PubMed  Google Scholar 

  56. Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma. 2007;24:S59–64.

    PubMed  Google Scholar 

  57. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43:8.

    Article  PubMed  Google Scholar 

  58. Gowing G, Jain MK. Injury patterns and outcomes associated with elderly trauma victims in Kingston, Ontario. Can J Surg. 2007;50(6):437–44.

    PubMed Central  PubMed  Google Scholar 

  59. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48:1040.

    Article  CAS  PubMed  Google Scholar 

  60. Cohn S. Pulmonary contusion: review of the clinical entity. J Trauma. 1997;42:973–9.

    Article  CAS  PubMed  Google Scholar 

  61. Cordell-Smith JA, Roberts N, Peek GJ, Firmin RK. Traumatic lung injury treated by extracorporeal membrane oxygenation (ECMO). Injury. 2006;37:29–32.

    Article  CAS  PubMed  Google Scholar 

  62. ARDSnet. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.

    Article  Google Scholar 

  63. Ullman DA, Wimpy RE, Fortune JB, et al. The treatment of patients with multiple rib fractures using continuous thoracic epidural narcotic infusions. Reg Anesth. 1989;14:43–7.

    CAS  PubMed  Google Scholar 

  64. John AD, Sieber FE. Age associated issues: geriatrics. Anesthesiol Clin North America. 2004;22:45–58.

    Article  CAS  PubMed  Google Scholar 

  65. Bickel H, Gradinger R, Kochs E, Forstl H. High risk of cognitive and functional decline after postoperative delirium. A three-year prospective study. Dement Geriatr Cogn Disord. 2008;26:26–31.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, New York University Medical Center, 550 First Avenue, New York, NY, 10016, USA

    Walid Alrayashi M.D.

Authors
  1. Walid Alrayashi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Walid Alrayashi M.D. .

Editor information

Editors and Affiliations

  1. Bellevue Hospital Center, New York University, New York, New York, USA

    Corey S. Scher

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Alrayashi, W. (2014). Anesthesia for the Geriatric Trauma Patient. In: Scher, C. (eds) Anesthesia for Trauma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0909-4_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-0909-4_17

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-0908-7

  • Online ISBN: 978-1-4939-0909-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation