Anesthetic Considerations for Trauma in Geriatric Patients
Assem Said Ahmed Elshora;
Abstract
ging is a progressive universally prevalent physiological process that produces measurable changes in the structure and decremental alteration of the function of tissues and organs.
Changes that are not universal or that do not increase in severity or magnitude in proportion to chronologic age are probably not manifestations of aging but, rather, are usually signs or symptoms of age-related disease. Example of major changes that are considered physiological in elderly subjects include, altered cerebral blood flow autoregulation, decline in afferent and efferent nerve conduction velocities and the rate of signal processing within brain stem and spinal cord, elevated both plasma epinephrine and norepinephrine at rest and in response to stress, reduced responsiveness of autonomic end-organs, decreased response of the cardiovascular system to beta-adrenoreceptor stimulation, decrease in lung recoil, decreases chest-wall compliance, maldistribution of pulmonary blood flow relative to distribution of tidal volume, linear decrease in arterial oxygen tension, decrease in anesthetic requirements and altered pharmacokinetic and pharmacodynamics of many of the drugs used in anesthesia (Ian McCONACHIE, 2006).
Trauma is the seventh leading cause of death in elderly; falls, motor vehicle crashes, and burns are the leading causes of fatalities induced by geriatric trauma. Falls are the most common cause of accidental injury in elderly with consequential soft tissue trauma and bone fractures. Rib fractures and head injuries may be a consequence of falls as well. Associated brain and/or lung injuries may result in additional complications and disability or death (Sarah and Ram, 2008).
After World War II, the subspecialty of prehospital emergency medicine evolved with anesthesiology’s leadership. In many countries, prehospital emergency medicine is considered the fourth pillar along with anesthesiology, critical care, and pain therapy. Prehospital endotracheal intubation and rapid sequence induction of anesthesia are critical skills in prehospital care. Yet prehospital advanced airway management may be too challenging for inexperienced providers and is associated with increased mortality and poor neurologic outcomes, especially after traumatic brain injury (Nagele and Hüpfl, 2015).
Efficient and effective pre-operative assessment of the elderly traumatized patient centers on accurate estimates of the physiologic disruption that will be produced by the intended surgery, and of the elderly patients cardiopulmonary functional reserve and overall metabolic and nutritional status (Muravchick S, 2000).
Efforts to identify the “best” intra-operative anesthetic agent or technique or approach for the elderly traumatized continue, but it seems that no anesthetic agent or technique is
Changes that are not universal or that do not increase in severity or magnitude in proportion to chronologic age are probably not manifestations of aging but, rather, are usually signs or symptoms of age-related disease. Example of major changes that are considered physiological in elderly subjects include, altered cerebral blood flow autoregulation, decline in afferent and efferent nerve conduction velocities and the rate of signal processing within brain stem and spinal cord, elevated both plasma epinephrine and norepinephrine at rest and in response to stress, reduced responsiveness of autonomic end-organs, decreased response of the cardiovascular system to beta-adrenoreceptor stimulation, decrease in lung recoil, decreases chest-wall compliance, maldistribution of pulmonary blood flow relative to distribution of tidal volume, linear decrease in arterial oxygen tension, decrease in anesthetic requirements and altered pharmacokinetic and pharmacodynamics of many of the drugs used in anesthesia (Ian McCONACHIE, 2006).
Trauma is the seventh leading cause of death in elderly; falls, motor vehicle crashes, and burns are the leading causes of fatalities induced by geriatric trauma. Falls are the most common cause of accidental injury in elderly with consequential soft tissue trauma and bone fractures. Rib fractures and head injuries may be a consequence of falls as well. Associated brain and/or lung injuries may result in additional complications and disability or death (Sarah and Ram, 2008).
After World War II, the subspecialty of prehospital emergency medicine evolved with anesthesiology’s leadership. In many countries, prehospital emergency medicine is considered the fourth pillar along with anesthesiology, critical care, and pain therapy. Prehospital endotracheal intubation and rapid sequence induction of anesthesia are critical skills in prehospital care. Yet prehospital advanced airway management may be too challenging for inexperienced providers and is associated with increased mortality and poor neurologic outcomes, especially after traumatic brain injury (Nagele and Hüpfl, 2015).
Efficient and effective pre-operative assessment of the elderly traumatized patient centers on accurate estimates of the physiologic disruption that will be produced by the intended surgery, and of the elderly patients cardiopulmonary functional reserve and overall metabolic and nutritional status (Muravchick S, 2000).
Efforts to identify the “best” intra-operative anesthetic agent or technique or approach for the elderly traumatized continue, but it seems that no anesthetic agent or technique is
Other data
| Title | Anesthetic Considerations for Trauma in Geriatric Patients | Other Titles | الاعتبارات التخديرية في إصابات مرضي كبار السن | Authors | Assem Said Ahmed Elshora | Issue Date | 2017 |
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