OB16 - Geriatrics & Coexisting
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Created by:
Coffeecup101 on September 18, 2011
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89 terms
Terms | Definitions |
|---|---|
 Life expectancy in the adult male has increased ___ years since the beginning of the 20th century.Elderly patients account for ___% of all hospital care days in the U.S. __ in __ patients is over the age of 65 | 30 years 48% 1 in 4 |
| ! Elderly & geriatric refers to pts over ___ yrs Aged is over ___ yrs | 65 80 |
| ! ____ is the maximal attainable age under optimal conditions ____ is typical longetivity under typical conditions | life span (110-115 yrs) life expectancy |
| There is a ___% increase in risk for perioperative death with an age over 65 | 300 |
| ! Which is better a cross-sectional or longitudinal study? | longitudinal |
| What is stochastical in regards to aging? | Aging is a stochastical process Stochastical is a random event with a certain amount of probability. |
| Are age-related changes and pathological changes synonymous? | no (pathological changes occur d/t disease process & occur at a higher incidence with age but do not always occur) |
| Does gender matter in regards to systolic hypertension occuring with aging? Why does it occur? (think heart not blood vessels) | no -fibrosis of elastic tissues in the ventricular wall |
| How would an EKG appear that reflects ventricular hypertrophy? |  R waves that are larger than normal in V leads (R waves normally increase progressively from V1 to V6) |
| Describe how CO is changed in the elderly | CO may decline but isn't noticed at rest d/t a decrease in demand (under load this decline becomes noticeable) |
| How does aging affect: -response to beta agonists -response to beta antagonists -parasympathetic tone -sympathetic tone How does this affect them under anesthesia? | -less response to beta agonists -preserved response to beta antagonists -decreased parasympathetic tone -increased sympathetic tone (to maintain CO) when you put them to sleep & remove the basal sympathetic tone you get a bigger drop in BP |
| Elderly pts cannot compensate by increasing ___ & ___, then compensate by ___ | cannot increase HR & CO can vasoconstriction |
| Does the carotid sinus or carotid bodies respond to stretch? | carotid sinus |
| Why are elderly prone to orthostatic hypotension? | carotid stretch baroreceptor reflex is blunted |
| ! How are compliance and elasticity related? | inversely proportional |
| The bony thorax is ___ elastic & ___ compliant with age | less elastic, more compliant |
| ! Describe elasticity & compliance of alveoli. How does this affect the size & stability of the alveoli? | less elastic, more compliant alveoli become dilated & collapse before FRC is reached (CV is increased) and air trapping occurs (like COPD) |
| What happens to the surface area of alveoli with aging? | decreases (from 75 m² to 60 m² by age 70) |
| ! How do the following change with age? -VC -RV -FRC -TLC -FEV1 -CV | -VC: ↓ -RV: ↑ -FRC: ~ (ERV drops) -TLC: ↓ (slowly) -FEV1: ↓ -CV: ↑ (position dependent) |
| PaO2 declines from 95 to ___ by age 75 | 73 |
| Why is HPV blunted in the elderly? | d/t stiff parenchyma that prevent the arteries from constricting |
| In the elderly, renal mass is ___ mostly in the ___ & is ____ by _____ | decreased mostly in the cortex & is replaced by fat & fibrotic tissue |
| In the elderly: GFR ___ Cr clearance ___ creatinine production ___ serum Cr ___ | GFR ↓s Cr clearance ↓s creatinine production ↓s serum Cr ~ |
| In the elderly: Hepatic enzyme function ___ Hepatic mass ___ | remains intact & functional decreases (decreased mass is why drug clearance impaired) |
| In the elderly plasma esterases ___ (gender) | decrease more in men than women (older men act like pregnant women in regards to plasma esterases) |
| What neurons tend to be lost more in the elderly (neuronal loss is highly selective) | those that are most metabolically active |
| What happens to NT production in the elderly? What are 4 examples of NTs affected? What happens to enzymes that metabolise NTs? What are 2 examples? | -decreased -ACh, NE, Dopamine, Tyrosine -increased activity -COMT, MAO |
| Why would a low MAP be even more detrimental in the elderly? (think neuro) | the CBF autoregulation curve is often right-shifted but remains intact (from 50-150 MAP to 80-180 to maintain constant CBF) |
| How is the hyperventilation-CO₂ response to CBF affected by age? | it remains intact |
| What are meissner's corpuscles & how are they altered by aging? | mechanoreceptors (ie touch, pain) exponentially decreased (less sensation) |
| ! In the elderly: The number of motor end plates ____ The number of ACh receptors ____ NMB doses ____ | decreases increases (negates the change) stay the same |
| The afferentiation threshold ____ in the elderly Which sensory modality is affected the most/least |  most: laryngeal reflex & taste least: simple pain |
| In the elderly: Adrenal mass size ___ NE concentrations ___ β-adrenergic response ___ α-adrenergic response ___ | decrease increase 2-3x (paradoxically) decreases stays the same |
| Why is CHF in the elderly so concerning to providing anesthesia? | -have high adrenergic tone & low reserve that when blunted can lead to catastrophic results |
| ! The volume of distribution of water soluble drugs in the elderly is ___ Vd of lipid soluble drugs is ___ Why? | decreased (more sensitive to versed) increased (longer duration of fentanyl) less body water, more body fat |
| ____ is what the drug does to the body ____ is what the body does to the drug | pharmacodynamics (d to b) pharmacokinetics (b to d) |
| Know this chart backwards & forwards (X axis, slope, potency, Y axis, etc.) |  |
| Why are elderly more sensitive to volatile anesthetics? | less brain mass to anesthetize |
| Which volatile anesthetic might be best in the elderly? | desflurane -low b:g PC = rapid equilibrium |
| What is the fundamental principle to follow in providing anesthesia to geriatrics? | work toward prompt and complete post op recovery (LOC, temp, etc.) |
| What type of anesthesia delivery is ideal for TURP because it will help in early detection of TURP syndrome? | spinal (but BP changes must be anticipated) (TURP syndrome = hyponatremia d/t irrigation fluids) |
| MAC of volatiles should be decreased ___ to ___ % per decade | 4-6% |
| ___ levels may be predictive of risk for perioperative morbidity & mortality d/t co-existing disease in the elderly | albumin |
| ____ may be more important than illness indices, and may be used as an index of success post operatively | functional status (exercise tolerance, etc.) |
| Anesthetic technique is much less important than good ____ in elderly pts | hemodynamic control |
| Organ function declines ___% per year starting at age __ | 1% starting at age 30 |
| ! Does plasma creatinine increase in the elderly? | no (GFR decreases but creatinine production also decreases d/t less muscle mass) |
| Elderly are prone to ___-natremia | hyponatremia (less able to retain sodium with declined renal function) |
| You need to be careful not to tilt the head back too far when intubating elderly d/t ____ insufficiency | vertebrobasilar artery may be insufficient (can cause stroke if occluded) |
| How would you adjust preop med dosages in the elderly? | be careful, start with lower dose (better would be to let MDs order & have nurses give) |
| What should you consider first with postop confusion in the elderly? (x2) | hypoxia? hypercarbia? |
| ____ is the most important risk factor for delirium What is the pathophysiology of delirium? Delirium is a common complication of ____ | co existing dimentia disturbance in neurotransmitter activity dimentia |
| How is delirium treated? | identify & treat the cause if possible (ie physostigmine for anticholinergic syndrome) |
| Post op delirium occurs in 10-60% of ___ surgeries Delirium risk also increases with ___ & ___ surgeries | 10-60% of hip fracture surgeries bypass & cataract |
| Dimentia occurs in just 1% of people at age ___ It ____ every ___ yrs 30-50% incidence at ___ yrs | 60 doubles every 5 years at 85 yrs |
| Determine if the following are cortical or sub-cortical dementias (picture) |  |
| Name 3 cortical dementias What are the differences between each? | Pick's Disease = degeneration of frontal & temporal lobe Alzheimers = a diffuse degeneration Frontal Lobar = frontal lobe degeneration |
| Name 3 sub-cortical dimentias | Parkinson's Huntington's (genetic) Creutzfeldt Jacob's (caused by eating human brain) |
| What are 4 potentially treatable causes of dementia? | aids neurosyphilis Vit B12 deficiency mental depression |
| The CT scan shows ___ & ___ in alzheimer's pts | ventricular dilation & cortical atrophy |
| ___ is characterized by a selective destruction of cholinergic neurons in the brain occuring early in the disease Choline acetyltransferase is decreased as much as __% | Alzheimer's 90% |
| What neurotransmitter is involved in Alzheimer's disease? | decreased ACh |
| How is the anesthetic plan altered for alzheimer's pts? (x2) | -avoid centrally acting drugs (sedation, atropine, etc.) -use minimal anesthesia & use drugs that don't last long |
| ____: pathologically excessive (and often incoherent) talking ____: meaningless repetition of another person's spoken words as a symptom of a psychiatric disorder ____: involuntary repetition of words, phrases, or sentences | Logorrhea Echolalia Palilalia |
| ___ is a frontal lobe cortical dementia that occurs less often than Alzheimer's & impairs the ability to plan & initiate goals & is associated with logorrhea, echolalia, & palalia | Pick's disease |
| _____ is a progressive infectious dementia | Creutzfeld-Jakob disease |
| _____ can cause dementia, gait disturbances, urinary incontinence, & cognitive declines & is treated by placing a shunt | normal pressure hydrocephalus |
| Parkinson's disease is characterized by the loss of ____ fibers normally present in the ____ of the brain | dopaminergic fibers in the substantia nigra |
| Males between the age of 40-70 are more prone to getting ____ | Parkinson's disease |
| The following are symptoms of Parkinson's: -___ spontaneous movements -___ of extremities -___ immobility -___ gait -rhythmic resting ___ (___ rolling) -___ skin -p___ abnormalities -___ crisis -d___ & d___ | -decreased spontaneous movements -rigidity of extremities -facial immobility -shuffling gait -rhythmic resting tremor (pill rolling) -oily skin -pupillary abnormalities -oculogyric crisis -dementia & depression |
| What happens if levadopa is withheld preop in an Parkinson's pt? | can lead to skeletal muscle rigidity that can impair breathing |
| ___ & ___ can occur in Parkinson's pts d/t the disease & the treatment (levadopa, MAOIs) | labile BP dysrhythmias |
| ____ dysfunction in Parkinson's pts can lead to increased risk for aspiration | autonomic dysfunction |
| ____ help to control resting tremors in Parkinson's pts ____ crosses the BBB & is converted to dopamine ____ increases the central delivery of levodopa | anticholinergics Levodopa Carbidopa (Sinemet) |
| ____ is a good premedication & for intraop sedation in Alzheimer's pts | diphenhydramine |
| What vasopressors should/shouldn't you use in Parkinson's pts? Why? | Use direct-acting They are often on MAOI or COMT inhibitors & indirect acting agents would cause issues |
| Ketamine + Parkinson's = | exaggerated sympathetic response |
| How does prolonged bedrest affect hemodynamics? | decreases circulating plasma volume (decreased CO & ortho hypoTN) |
| ! Vomitting & diarrhea cause ___-tonic dehydration | isotonic (balance of water & Na loss) |
| ! Sweating causes ___-tonic dehydration | hypertonic (water loss exceeds sodium loss) |
| ! Diuretics cause ___-tonic dehydration | hypotonic (Na loss exceeds water loss) |
| ! Hyper- vs hypo-tonic dehydration Na levels | hypo- Na less than 135 mEq/L Iso- normal Na hyper- Na greater than 145 mEq/L |
| Bun/Cr ratio ___ indicated dehydration | >25 |
| Glaucoma with an IOP greater than ___ mmHg can cause retinal ischemia | 21 |
| ___ is an age-related condition where the lens of the eye becomes stiff | presbyopia |
| Progeria is also called ____-____ syndrome, an autosomal recessive disorder | Hutchinson-Gilford syndrome (premature aging) |
| Mean survival of progeria is ___ years | 13 (death by 25 is common) |
| ___ is a form of osteoarthrytis of the spine | spondylosis |
| Women lose ~50% of cancellous bone & 30% of cortical bone in their lifetime d/t osteoporosis Men lose ~30% cancellous, 20% cortical What is cancellous? |  cancellous = spinal column & end of long bones |
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