Skip to main content

Cardiac Anesthesia in the Elderly

  • Chapter
  • First Online:
Cardiothoracic Surgery in the Elderly

Abstract

Elderly patients have more comorbidities and are increasingly undergoing more complex procedures. Despite the ever aging population, expected mortality continues to decline. This is based in part on our increased understanding of the complex physiology of the elderly and improved medications and monitoring techniques now in use to mitigate adverse outcomes.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
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

Institutional subscriptions

References

  1. Keefover RW. Aging and cognition. Neurol Clin. 1998;16(3):635–48.

    Article  PubMed  CAS  Google Scholar 

  2. Pandharipande P, Cotton BA, Shintani A, Thompson J, Pun BT, Morris Jr JA, et al. Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma. 2008;65(1):34–41.

    Article  PubMed  Google Scholar 

  3. Larsen SF, Zaric D, Boysen G. Postoperative cerebrovascular accidents in general surgery. Acta Anaesthesiol Scand. 1988;32(8):698–701.

    Article  PubMed  CAS  Google Scholar 

  4. Parikh S, Cohen JR. Perioperative stroke after general surgical procedures. NY State J Med. 1993;93(3):211–5.

    Google Scholar 

  5. Kim J, Gelb AW. Predicting periopeative stroke. J Neurosurg Anesthesiol. 1995;7(3):211–5.

    Article  PubMed  CAS  Google Scholar 

  6. Kam PC, Calcroft RM. Peri-operative stroke in general surgical patients. Anesthesia. 1997;52(9):879–83.

    Article  CAS  Google Scholar 

  7. Limburg M, Wijdicks EF. LiH. Ischemic stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology. 1998;50(4):895–901.

    Article  PubMed  CAS  Google Scholar 

  8. Landercasper J, Merz BJ, Cogbill TH, et al. Perioperative stroke risk in 173 consecutive patients with a past history of stroke. Arch Surg. 1990;125:986–9.

    Article  PubMed  CAS  Google Scholar 

  9. Zile MR, Brustsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: part II: Causal mechanisms and treatment. Circulation. 2002;105:1503.

    Article  PubMed  Google Scholar 

  10. Vasan R, Larson M, Benjamin E, et al. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol. 1999;33:1948–55.

    Article  PubMed  CAS  Google Scholar 

  11. Ebert TJ, Rooke GA. Alterations in circulatory function. In: Silverstein JH, Rooke GA, Reves JG, McLeskey CH, editors. Geriatric anesthesiology. 2nd ed. New York: Springer; 2008. p. 137–48.

    Chapter  Google Scholar 

  12. Groban L, Dolinski SY. Transesophageal echocardiographic evaluation of diastolic function. Chest. 2005;128(5):3652–63.

    Article  PubMed  Google Scholar 

  13. Vinch CS, Aurigemma GP, Simon HU, et al. Analysis of left ventricular systolic function using midwall mechanics in patients >60 years of age with hypertensive heart disease and heart failure. Am J Cardiol. 2005;19:59–64.

    Google Scholar 

  14. Turner MJ, Cm M, Spina RJ, et al. Effects of age and gender on cardiovascular responses to phenylephrine. J Gerontol Med Sci. 1999;54A:M17–24.

    Article  CAS  Google Scholar 

  15. Brodde O-E, Leineweber K. Autonomic receptor systems in the failing and aging human heart: similarities and differences. Eur J Pharmacol. 2004;500:167–76.

    Article  PubMed  CAS  Google Scholar 

  16. Carti-Ceba R, Spring J, Gajic O, Warner D. The aging respiratory system: anesthetic strategies to minimize perioperative pulmonary complications. In: Silverstein JH, Rooke GA, Reves JG, McLeskey CH, editors. Geriatric anesthesiology. 2nd ed. New York: Springer; 2008. p. 149–64.

    Chapter  Google Scholar 

  17. McEvoy MD, Reves JG. Intravenous hypnotic anesthetics. In: Silverstien JH, Rooke GA, Reves JG, McLeskey CH, editors. Geriatric anesthesiology. 2nd ed. New York: Springer; 2008. p. 229–45.

    Chapter  Google Scholar 

  18. Epstein M. Aging and the kidney. J Am Soc Nephrol. 1996;7:1106–22.

    PubMed  CAS  Google Scholar 

  19. Cogliati AA, Vellutini R, Nardini A, Urovi S, Hamdan M, Landoni G, et al. Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study. J Cardiothorac Vasc Anesth. 2009;23(1):128.

    Article  Google Scholar 

  20. Jack Jr L, Boseman L, Vinicor F. Aging Americans and diabetes. A public health and clinical response. Geriatrics. 2004;59:14–7.

    PubMed  Google Scholar 

  21. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–31.

    Article  PubMed  CAS  Google Scholar 

  22. Finfer S, Chittock DR, et al. Intesnsive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.

    Article  PubMed  Google Scholar 

  23. Phillips PA, Rolls BY, Ledingham JG, Forsling ML, Morton JJ, Crowe MJ. Reduced thirst after water deprivation in healthy elderly men. N Engl J Med. 1984;311:753–9.

    Article  PubMed  CAS  Google Scholar 

  24. Weidmann P, Demyttenaere-Bursztein S, Maxwell MH, DeLima J. Effect of againg on plasma rennin and aldosterone in normal man. Kidney Int. 1975;8:325–33.

    Article  PubMed  CAS  Google Scholar 

  25. Robin ED. Defenders of the pulmonary artery catheter. Chest. 1988;93:1059.

    PubMed  CAS  Google Scholar 

  26. Dalen JE, Bone RC. Is it time to pull the pulmonary artery catheter? JAMA. 1996;276:916.

    Article  PubMed  CAS  Google Scholar 

  27. Roberts KW, Crnkowic AP, Linneman LJ. Near-infrared spectroscopy detects critical cerebral hypoxia during carotid endarterectomy in awake patients. Anesthesiology. 1998;89(3A):A934.

    Article  Google Scholar 

  28. Cho H, Nemoto E, Yonas H. Cerebral monitoring by means of oximetry and somatosensory evoked potential during carotid endarterectomy. J Neurosurg. 1998;89:533.

    Article  PubMed  CAS  Google Scholar 

  29. Monk TG, Reno KA, Olsen BS, et al. Postoperative cognitive ­dysfunction is associated with cerebral oxygen desaturations. Anesthesiology. 2000;93:A167.

    Google Scholar 

  30. Vohra HA, Modi A, Ohri SK. Does use of intra-operative cerebral regional oxygen saturation monitoring during cardiac surgery lead to improved clinical outcomes? Interact Cardiovasc Thorac Surg. 2009;9(2):318–22.

    Article  PubMed  Google Scholar 

  31. Myles PS, Leslie K, McNeil J, et al. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomized controlled trial. Lancet. 2004;363:1757.

    Article  PubMed  CAS  Google Scholar 

  32. Kahn RA, Shernan SK, Konstadt SN. Intraoperative echocardiography. In: Kaplan JA, Reich DL, Lake CL, Konstadt SN, editors. Kaplan’s cardiac anesthesia. 5th ed. Philadelphia: Saunders Elsevier; 2006. p. 437–88.

    Google Scholar 

  33. Thys DM, et al. Practice guidelines for perioperative transesophageal echocardiography. Anesthesiology 2010;112(1).

    Google Scholar 

  34. Eltzschig HK, Rosenberger P, Loffler M, Fox JA, Aranki SF, Shernan SK. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12, 566 patients undergoing cardiac surgery. Ann Thorac Surg. 2008;85(3):845–52.

    Article  PubMed  Google Scholar 

  35. Hartman GS, Yao FS, Bruefach 3rd M, et al. Severity of aortic atheromatous disease diagnosed by transesophageal echocardiography predicts stroke and other outcomes associated with coronary artery surgery: a prospective study. Anesth Analg. 1996;83:701.

    PubMed  CAS  Google Scholar 

  36. Katz ES, Tunick PA, Rusinek H, et al. Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophagela echocardiography. J Am Coll Cardiol. 1992;20:70.

    Article  PubMed  CAS  Google Scholar 

  37. Rosenberger P, Shernan SK, Loffler M, Shekar PS, Tuli FJA, JK NM, et al. The influence of epiaortic ultrasonography on intraoperative surgical management in 6051 cardiac surgical patients. Ann Thorac Surg. 2008;85(2):548–53.

    Article  PubMed  Google Scholar 

  38. Tuman KJ, McCarthy RJ, Spiess BD, Ivankovich AD. Comparison of anesthetic techniques in patients undergoing heart valve replacement. J Cardiothorac Anesth. 1990;4(2):159–67.

    Article  PubMed  CAS  Google Scholar 

  39. Tuman KJ, McCarthy RJ, Spiess BD, DaValle M, Dabir R, Ivankovich AD. Does choice of anesthetic agent significantly affect outcome after coronary artery surgery? Anesthesiology. 1989;70(2):189–98.

    Article  PubMed  CAS  Google Scholar 

  40. Schnider TW, Minto CF, Gumbus PL, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology. 1998;88(5):1170–82.

    Article  PubMed  CAS  Google Scholar 

  41. Ball C, Westhorpe R. The history of intravenous anaesthesia: the barbiturates. Part 1. Anaesth Intensive Care. 2001;19(2):97.

    Google Scholar 

  42. Ball C, Westhorpe R. The history of intravenous anaesthesia: the barbiturates. Part 2. Anaesth Intensive Care. 2001;29(3):219.

    PubMed  CAS  Google Scholar 

  43. Ball C, Westhorpe R. The history of intravenous anaesthesia: the barbiturates. Part 3. Anaesth Intesive Care. 2001;29(4):323.

    CAS  Google Scholar 

  44. Vinclair M, Broux C, Faure P, Brun J, Genty C, Jaquot C, et al. Duration of adrenal inhibition following a single dose of etomidate in critically ill patients. Intesive Care Med. 2008;34(4):714–9.

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  46. Harper KW, Collier PS, Dundee JW, et al. Age and nature of operation influence the pharmacokinetics of midazolam. Br J Anesth. 1985;57:866.

    Article  CAS  Google Scholar 

  47. Ishikawa S, Kugawa S, Neya K, Suzuki Y, Kawasaki A, Hayama T, et al. Hemodynamic effects of dexmedetomidine in patients after cardiac surgery. Minerva Chir. 2006;61(3):215–9.

    PubMed  CAS  Google Scholar 

  48. Maldonado JR, Wysong A, van der Starre PJ, Block T, Miller C, Reitz BA. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery. Psychosomatics. 2009;50(3):206–17.

    Article  PubMed  CAS  Google Scholar 

  49. Stanley TH, Webster LR. Anesthetic requirements and cardiovascular effects of fentayl-oxygen and fentanyl-diazempam-oxygen anesthesia in man. Anesth Analg. 1978;57:411.

    PubMed  CAS  Google Scholar 

  50. Murphy GS, Szokol JW, Marymont JH, et al. Morphine-based ­cardiac anesthesia provides superior early recovery compared with fentanyl in elective cardiac surgery patients. Anesth Analg. 2009;109(2):311–9.

    Article  PubMed  CAS  Google Scholar 

  51. Ouattara A, Lecomte P, LeManach Y, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005;103:4.

    Article  Google Scholar 

  52. Egi M, Bellomo R, Stachowski E, et al. Variability of blood glucose concentration and short-term mortality in critically ill patients. Anesthesiology. 2006;105:2.

    Article  Google Scholar 

  53. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the surgical intensive care unit. N Engl J Med. 2001;345:1359.

    Article  PubMed  Google Scholar 

  54. Nauphal M, El-Khatib M, Taha S, Haroun-bizri S, Alameddine M, Baraka A. Effect of alpha-stat vs. pH-stat strategies on cerebral oximetry during moderate hypothermic cardiopulmonary bypass. Eur J Anaesthesiol. 2007;24(1):15–9.

    PubMed  CAS  Google Scholar 

  55. Patel RL, Turtle MR, Chambers DJ, et al. Alpha-stat acid-base regulation during cardiopulmonary bypass improves neuropsychologic outcome in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1996;111:1267.

    Article  PubMed  CAS  Google Scholar 

  56. Landoni G, Fochi O, Tritapep L, Garracino F, Belloni I, Bignami E, et al. Cardiac protection by volatile anesthetics. A review. Minerva Anestesiol. 2009;75(5):269–73.

    PubMed  CAS  Google Scholar 

  57. Culley DJ, Monk TG, Crosby G. Postoperative central nervous system dysfuncion. In: Silverstein JH, Rooke GA, Reves JG, McLeskey CH, editors. Geriatric anesthesiology. 2nd ed. New York: Springer; 2008. p. 123–36.

    Chapter  Google Scholar 

  58. Abernathy JH. Cardiac procedures. In: Silverstien JH, Rooke GA, Reves JG, McLeskey CH, editors. Geriatric anesthesiology. 2nd ed. New York: Springer; 2008. p. 229–45.

    Google Scholar 

  59. Reves JH, Reeves S, Abernathy JH, editors. Atlas of cardiothoracic anesthesia. 2nd ed. New York: Current Medicine Group, Springer; 2009.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to James H. Abernathy III .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Nelson, E.W., Abernathy, J.H. (2011). Cardiac Anesthesia in the Elderly. In: Katlic, M. (eds) Cardiothoracic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0892-6_28

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0892-6_28

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0891-9

  • Online ISBN: 978-1-4419-0892-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics