Anesthetic Management Of Patients With Alzheimer's Disease
Ola Ahmed Saad Ali Lashin;
Abstract
heimer's disease (AD) is the most prevalent neurodegenerative disorder in elderly people; it afflicts an estimated 26.6 million people worldwide, and without a major therapeutic breakthrough, the prevalence of AD is expected to increase to more than 100 million by 2050.
The so called “great elderly” patients with numerous co-morbidities, including Alzheimer’s disease (AD) or progressive dementia, are more and more often scheduled to undergo surgery for various pathologies. The main aim is to avoid deterioration of underlying mental diseases, the development of Postoperative Cognitive Dysfunctions (POCD), and the increase of morbidity and hence, the economical cost of patient care. The negative influence of surgery, anesthesia, andcare on this category of patients is often underestimated or neglected.
The risk from anesthesia is more related with the presence of co-existing disease than with the age of the patient. Thus, it is more important to understand the physiology of aging, determine the patient's status and estimate the physiologic reserve in the pre-anesthetic evaluation.
Anesthesia should be safe with smooth induction, maintenance and quick reversal without producing any cardiovascular, respiratory and nervous complications. Choice of anesthesia depends on the patient’s general condition, nature of surgical procedure and the experience of the anesthesiologist. Psychological preparation, appropriate premedication and patient warming is important. Airway maintenance may be more difficult because of osteoporotic mandibles, loose teeth and cervical spondylosis.
Post-operative Pain control and drug management are very important in minimizing post-operative delirium and confusion.Postoperative delirium or POCD usually appearwithin 5 days after surgery.Monitoring shouldbe performed by appropriately trained clinicians andnursing using different scoring systems of which Pain Assessment inAdvancedDementia (PAINAD) is the most suitable.
References
Abdulla A, Adams N, Bone M, et al. (2013):Guidance on the management of pain in older people. Age Ageing 42 (1): i1-i57.
Abualsaud AO and Eisenberg MJ. (2010): Perioperative management of patients with drug-eluting stents. JACC: Cardiovascular Interventions 3 (2): 131–42.
Adedeji R, Oragui E, Khan W, et al. (2010):The importance of correct patient positioning in theatres and implications of mal-positioning. Journal of Perioperative Practice 20 (4): 143-7.
Ansaloni L, Catena1 F, Chattat R, et al. (2010):Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. British Journal of Surgery 97 (2): 273-80.
Arevalo Rodriguez I. Smailagic N, et al. (2015):Mini-Mental Status Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI)". Cochrane Database of Systematic Reviews 2015.
The so called “great elderly” patients with numerous co-morbidities, including Alzheimer’s disease (AD) or progressive dementia, are more and more often scheduled to undergo surgery for various pathologies. The main aim is to avoid deterioration of underlying mental diseases, the development of Postoperative Cognitive Dysfunctions (POCD), and the increase of morbidity and hence, the economical cost of patient care. The negative influence of surgery, anesthesia, andcare on this category of patients is often underestimated or neglected.
The risk from anesthesia is more related with the presence of co-existing disease than with the age of the patient. Thus, it is more important to understand the physiology of aging, determine the patient's status and estimate the physiologic reserve in the pre-anesthetic evaluation.
Anesthesia should be safe with smooth induction, maintenance and quick reversal without producing any cardiovascular, respiratory and nervous complications. Choice of anesthesia depends on the patient’s general condition, nature of surgical procedure and the experience of the anesthesiologist. Psychological preparation, appropriate premedication and patient warming is important. Airway maintenance may be more difficult because of osteoporotic mandibles, loose teeth and cervical spondylosis.
Post-operative Pain control and drug management are very important in minimizing post-operative delirium and confusion.Postoperative delirium or POCD usually appearwithin 5 days after surgery.Monitoring shouldbe performed by appropriately trained clinicians andnursing using different scoring systems of which Pain Assessment inAdvancedDementia (PAINAD) is the most suitable.
References
Abdulla A, Adams N, Bone M, et al. (2013):Guidance on the management of pain in older people. Age Ageing 42 (1): i1-i57.
Abualsaud AO and Eisenberg MJ. (2010): Perioperative management of patients with drug-eluting stents. JACC: Cardiovascular Interventions 3 (2): 131–42.
Adedeji R, Oragui E, Khan W, et al. (2010):The importance of correct patient positioning in theatres and implications of mal-positioning. Journal of Perioperative Practice 20 (4): 143-7.
Ansaloni L, Catena1 F, Chattat R, et al. (2010):Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. British Journal of Surgery 97 (2): 273-80.
Arevalo Rodriguez I. Smailagic N, et al. (2015):Mini-Mental Status Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI)". Cochrane Database of Systematic Reviews 2015.
Other data
| Title | Anesthetic Management Of Patients With Alzheimer's Disease | Other Titles | العنايــة التخديريــة للمرضــى المصابيـن بمــرض الزهايمــر | Authors | Ola Ahmed Saad Ali Lashin | Issue Date | 2017 |
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