Anesthetic Consideration for Geriatric Patients

Amornyotin, Somchai

doi:10.5772/intechopen.97003

Cited by 3 publications

(9 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Respons barorefleks tidak dapat menjaga stabilitas hemodinamika pada saat hipotensi ortostatik ataupun hipovolemia. 6,13 Pada COT terjadi interaksi neurokardiak yang memperberat perubahan normal pada sistem kardiovaskular akibat penuaan. COT menyebabkan peningkatan katekolamin endogen yang mengakibatkan iskemia subendokardial, disfungsi miokardial, disautonomia, dan abnormalitas konduksi.…”

Section: Pembahasanunclassified

“…Kombinasi dari perubahan fisiologis akibat penuaan dan komplikasi kardiak dari COT menyebabkan keterbatasan kemampuan dari pasien geriatri untuk merespon stres yang terjadi akibat trauma. 3,13 Sistem Respirasi Sesuai penuaan maka kapasitas cadangan paru juga menurun. Hal ini diakibatkan menurunnya compliance dinding dada, berkurangnya elastisitas parenkim paru, dan mudah kolapsnya alveolus.…”

Section: Pembahasanunclassified

“…Terjadi juga penurunan respons ventilasi terhadap hipoksemia dan hiperkapnia. 12,13 Komplikasi sistem respirasi akibat COT sinergistik terhadap perubahan akibat penuaan. Cedera kepala berat dapat menyebabkan depresi napas atau apnea, ensefalopati iskemik hipoksik, edema paru neurogenik, aspirasi pneumonia, dan infeksi paru dengan sindrom distres pernapasan akut.…”

Section: Pembahasanunclassified

“…Komplikasi ini bersama dengan proses penuaan dapat mengakibatkan gagal napas dengan cepat sehingga pasien membutuhkan bantuan pernapasan untuk menjaga kecukupan pertukaran gas. 12,13 Sistem Renal Seiring penuaan terjadi juga penurunan dari fungsi ginjal; penurunan laju filtrasi glomerulus, kemampuan untuk konsentrasi urine terganggu. Monitor urine output selama operasi sangat penting.…”

Section: Pembahasanunclassified

“…Penurunan fungsi ginjal juga menyebabkan perlunya penyesuaian obatobatan yang dieksresikan melalui ginjal. 12,13 Sistem Endokrin Perubahan sistem endokrin yang normal pada penuaan adalah turunnya sekresi tiroksin dan insulin. Pada COT kaitannya adalah pencegahan kondisi hiperglikemia sebagai cedera otak sekunder yang dapat memperburuk luaran pasien.…”

Section: Pembahasanunclassified

See 4 more Smart Citations

Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma

Widiastuti

Rachman

Umar

2022

JNI

View full text Add to dashboard Cite

Worldwide, the incidence of traumatic brain injury in geriatrics is 7–34%, with falls as the most common cause. Subdural hemorrhage is the most common injury that occur and is associated with the aging process of the brain, making geriatric patients prone developing subdural hemorrhage. A 72-years-old female came with a headache after fell to the ground 6 days before hospital admission. Physical examination revealed E3M5V6 without neurologic deficits and hemodynamically stable. A computed tomography scan resulted in subdural hematoma in right frontotemporoparietal region causing midline shifting to the left, subarachnoid hemorrhage in the left frontal region, intracerebral hemorrhage in the left temporal lobe. The patient underwent craniotomy evacuation of hematoma and lasted for 3 hours under general anesthesia. Anesthetic concerns are neuroanesthesia and geriatric patient considering the aging process affects physiologic and pharmacologic changes, comorbidities and polypharmacy. Comprehensive perioperative management is essential to prevent secondary brain injury and improve the outcome.

show abstract

Section: Pembahasanunclassified

See 3 more Smart Citations

Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma

Widiastuti

Rachman

Umar

2022

JNI

View full text Add to dashboard Cite

show abstract

A Prospective, Randomized, Open-Label Study Comparing Recovery Characteristics between Desflurane and Sevoflurane Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy

Sailaja,

Lakshminarasimhaiah,

Srinivas

2023

J Neuroanaesth Crit Care

View full text Add to dashboard Cite

Background Sevoflurane and desflurane are the two commonly used volatile anesthetics and it is mandatory to comprehend their hemodynamic and recovery profiles to ensure safe administration and early recovery in elderly neurosurgical patients. The primary objective of the study was to compare the recovery profiles of sevoflurane and desflurane in elderly patients undergoing supratentorial craniotomy. The secondary outcome measures studied were intraoperative hemodynamic changes, intraoperative brain condition, and early postoperative cognition using short orientation memory concentration test (SOMCT). Methods The prospective, open-labeled study involving 78 elderly patients undergoing elective supratentorial craniotomies randomized the subjects into sevoflurane and desflurane groups in the ratio of 1:1 (39 each). Pre- and early postoperative cognitive function of the patient was assessed using SOMCT. Time for emergence, extubation, and recovery were also compared between the groups. Hemodynamic parameters during surgery and brain relaxation were recorded. Student's t-test was used to find the significance of study parameters on a continuous scale and chi-squared test to find the significance of study parameters on a categorical scale between two groups. Results The mean emergence time (minutes) was found to be significantly longer in sevoflurane group as opposed to desflurane (9.44 ± 2.07 vs. 8.28 ± 2.53, p = 0.02). Similarly, the mean recovery time was significantly longer for sevoflurane group than desflurane (17.33 ± 3.36 vs. 15.64 ± 4.63, p = 0.03). A statistically significant difference in pre- and early postoperative SOMCT was observed between the two groups (5.31 ± 2.89 vs. 4.33 ± 1.74, p = 0.04) with better early postoperative SOMCT (p = 0.05) in desflurane group. However, extubation time, average duration of surgery, brain relaxation, and modified Aldrete score were comparable between the groups. Conclusion Elderly patients who received desflurane had a shorter emergence and recovery time compared with sevoflurane. Improved early postoperative SOMCT scores were noted in desflurane group.

show abstract

Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation of elderly patients undergoing ERCP

Zhang,

et al. 2024

BMC Gastroenterol

View full text Add to dashboard Cite

Background Proper sedation of patients, particularly elderly individuals, who are more susceptible to sedation-related complications, is of significant importance in endoscopic retrograde cholangiopancreatography (ERCP). This study aims to assess the safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation in elderly patients undergoing ERCP, compared to a group of middle-aged patients. Methods The medical records of 610 patients with common bile duct stones who underwent elective ERCP under deep sedation with a three-drug regimen, including midazolam, alfentanil, and propofol at Shandong Provincial Third Hospital from January 2023 to September 2023 were retrospectively reviewed in this study. Patients were categorized into three groups: middle-aged (50–64 years, n = 202), elderly (65–79 years, n = 216), and very elderly (≥ 80 years, n = 192). Intraoperative vital signs and complications were compared among these groups. Results The three groups showed no significant difference in terms of intraoperative variation of systolic blood pressure (P = 0.291), diastolic blood pressure (P = 0.737), heart rate (P = 0.107), peripheral oxygen saturation (P = 0.188), bispectral index (P = 0.158), and the occurrence of sedation-related adverse events including hypotension (P = 0.170) and hypoxemia (P = 0.423). Conclusion The results suggest that a low-dose three-drug regimen consisting of midazolam, alfentanil, and propofol seems safe and effective for deep sedation of elderly and very elderly patients undergoing ERCP procedures. However, further studies are required to verify these findings and clarify the benefits and risks of this method.

show abstract

Anesthetic Consideration for Geriatric Patients

Cited by 3 publications

References 33 publications

Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma

Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma

A Prospective, Randomized, Open-Label Study Comparing Recovery Characteristics between Desflurane and Sevoflurane Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy

Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation of elderly patients undergoing ERCP

Contact Info

Product

Resources

About