Skip to main content
SpringerLink
Log in

Anesthetic Management

  • Living reference work entry
  • First Online:
Principles and Practice of Geriatric Surgery

Abstract

Elderly patients will constitute 20% of the population in the USA by 2030. This phenomenon has clear implications for healthcare including perioperative care. While this group consumes approximately 35% of the surgical services, their perioperative outcomes lag behind other age groups.

While traditional anesthetic management focused in the intraoperative portion, it is peremptory to provide comprehensive and coordinated care along the perioperative continuum. In the preoperative phase, a systematic review of systems and comorbidities remains most important. However, the concepts of frailty as a determinant of outcomes and pre-habilitation in order to further optimize those presenting for anesthesia and surgery provide new perspectives in the care of these patients. Intraoperative, assuring organ perfusion, proper ventilation, and minimizing the physiological responses to surgery are key aspects. In addition prevention of awareness and movement are also important goals. Postoperatively, assessing and treating pain properly; avoiding, recognizing, and treating postoperative delirium; preventing falls; and assuring proper hydration and nutrition are important aspects in the management of these patients.

The care of the surgical geriatric patient is complex and requires excellent coordination and communication across all healthcare providers involved in their care. The perioperative surgical home promotes such collaborative effort and has proven results in different surgical service lines. This approach might prove useful when caring for the older adult across all the phases of the perioperative continuum.

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

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Cohn D, Taylor P. Baby boomers approach 65- glumly. Available from http://www.pewsocilatrends.org/2010/12/20/baby-boomers-approach-65-glumly/ Published12/20/2010. Accessed 15 Feb 2017

  2. US Department of Health and Human Services, NIH, National Institute on Aging. Health Disparities Strategic Plan: Fiscal years 2009–2013. Available from https://www.nia.nih.gov/about/health-disparities-strategic-plan-fiscal-years-2009-2013. Accessed 15 Feb 2017

  3. The elderly population. U.S. Census Bureau. Available from http://eresources.library.mssm.edu:2114/population/www/pop-profile/elderpop.html. Accessed 15 Feb 2017

  4. Cullen KA, Hall MJ, Golosinskiy A (2009) Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 11:1–25

    Google Scholar 

  5. Stanton MW, Rutherford MK (2005) The high concentration of U.S. health care expenditures. Agency for Healthcare Research and Quality, Rockville. Research in Action Issue 19. AHRQ Pub. No.06-0060

    Google Scholar 

  6. Monk TG, Saini V, Weldon BC et al (2005) Anesthetic management and one-year mortality after non-cardiac surgery. Anesth Analg 100:4–10

    Article  PubMed  Google Scholar 

  7. Kheterpal S, O’Reilly M, Englesbe MJ et al (2009) Preoperative and intraoperative predictors of cardiac adverse events after general, vascular and urological surgery. Anesthesiology 110:58–66

    Article  PubMed  Google Scholar 

  8. Turrentine FE, Wang H, Simpson VB et al (2006) Surgical risk factors morbidity, and mortality in elderly patients. J Am Coll Surg 203:865–877

    Article  PubMed  Google Scholar 

  9. Munro D. The year in health care charts. Available from http://www.forbes.com/sites/danmunro/2012/12/30/2012-the-year-in-healthcare-charts. Accessed 17 Feb 2017

  10. Tiret L, Desmonts JM, Hatton F et al (1986) Complications associated with anaesthesia – a prospective survey in France. Can Anaesth Soc J 33:336–344

    Article  CAS  PubMed  Google Scholar 

  11. Hamel MB, Henderson WG, Khuri SF et al (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53:424–429

    Article  PubMed  Google Scholar 

  12. Manku K, Leung JM (2003) Prognostic significance of postoperative in-hospital complications in elderly patients. II. Long-term quality of life. Anesth Analg 96:590–594

    PubMed  Google Scholar 

  13. Schwarze M, Barnato AE, Rathouz PJ et al (2015) Development of a list of high risk operations for patients 65 years and older. JAMA Surg 150:325–331

    Article  PubMed  PubMed Central  Google Scholar 

  14. Merani S, Payne J, Padwal RS et al (2014) Predictors of in-hospital mortality and complications in very elderly patients undergoing emergency surgery. World J Emerg Surg 9:43

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lees M, Merani S, Tauh K et al (2015) Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis. Can J Surg 58:312–317

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chow WB, Rosenthal RA, Merkow RP et al (2012) Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 215(4):453–466

    Article  PubMed  Google Scholar 

  17. Mohanty S, Rosenthal RA, Russell MM et al (2016) Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg 222:930–947

    Article  PubMed  Google Scholar 

  18. Cook D, Rooke GA (2003) Priorities in perioperative geriatrics. Anesth Analg 96:1823–1836

    Article  PubMed  Google Scholar 

  19. Kim S, Marsh AP, Rustowicz L et al (2016) Self-reported mobility in older patients predicts early postoperative outcomes after elective noncardiac surgery. Anesthesiology 124:815–825

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Panel on Prevention of falls in older persons. American Geriatric Society and British Geriatric Society (2011) Summary of the updated American Geriatric Society/British Geriatric Society clinical guidelines prevention of fall in older persons. J Am Geriatr Soc 59:1458–1157

    Google Scholar 

  21. Fried LP, Tangen CM, Watson J (2001) Frailty in older adults: evidence of a phenotype. J Gerentol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  Google Scholar 

  22. Makary MA, Segev DL, Pronovost PJ et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210:901–908

    Article  PubMed  Google Scholar 

  23. Robinson TN, DS W, Pointer L et al (2013) Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 206:544–550

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lin HS, Watts JN, Peel NM, Hubbard RE (2016) Frailty and postoperative outcomes in older surgical patients: a systematic review. BMC Geriatr 16:157

    Article  PubMed  PubMed Central  Google Scholar 

  25. McIsaac DI, Wijeysundera DM, Huand A et al (2017) Association of hospital volume of frail surgical patients care for with outcomes after elective Major noncardiac surgery. Anesthesiology 126:602–613

    Article  PubMed  Google Scholar 

  26. ACS/NSQUIP Surgical Risk Calculator. Available from http://riskcalculator.facs.org/RiskCalculator/

  27. Oosting E, Jans MP, Dronkers JJ (2012) Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Arch Phys Med Rehabil 93(4):610–616

    Article  PubMed  Google Scholar 

  28. Dronkers JJ, Lamberts H, Reutelingsperger IM et al (2010) Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. Clin Rehabil 24:614–622

    Article  CAS  PubMed  Google Scholar 

  29. Denison HJ, Cooper C, Sayer AA, Robinson SM (2015) Prevention and optimal management of sarcopenia: a review of combined exercise and nutrition interventions to improve muscle outcomes in older people. Clin Interv Aging 10:859–869

    PubMed  PubMed Central  Google Scholar 

  30. Saleh AJ, Tang GX, Hadi SM et al (2015) Preoperative cognitive intervention reduces cognitive dysfunction in elderly patients after gastrointestinal surgery: a randomized controlled trial. Med Sci Monit 21:798–805

    Article  PubMed  PubMed Central  Google Scholar 

  31. Strong For Surgery. Available from www.becertain.org/strong_for_surgery. Accessd 1 Mar 2017

  32. Rooke GA (2003) Cardiovascular aging and anesthetic implications. J Cardiothorac Vasc Anesth 17:512–523

    Article  PubMed  Google Scholar 

  33. Rooke GA, Freund PR, Jacobson AF (1997) Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg 85:99–105

    CAS  PubMed  Google Scholar 

  34. Sanders D, Dudley M, Groban L (2009) Diastolic dysfunction, cardiovascular aging, and the anesthesiologist. Anesthesiol Clin 27:497–517

    Article  PubMed  PubMed Central  Google Scholar 

  35. Cartin-Ceba R, Sprung J, Gajic O, Warner DO (2008) The aging respiratory system: anesthetic strategies to minimize perioperative pulmonary complications. In: Silverstein JH, Rooke GA, Reves JG, McLeskey CH (eds) Geriatric anesthesiology, 2nd edn. New York, Springer, pp 149–164

    Chapter  Google Scholar 

  36. Neto AS, Hemmes SNT, Barbas CSV et al (2015) Protective versus conventional ventilation for surgery. A systematic review and individual patient data meta-analysis. Anesthesiology 123:66–78

    Article  Google Scholar 

  37. Grosse-Sundrup M, Henneman JP, Sandberg WS et al (2012) Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ 345:e6329

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Murphy GS, Szokol JW, Avram MJ et al (2015) Residual neuromuscular block in the elderly. Incidence and clinical implications. Anesthesiology 123:1322–1336

    Article  PubMed  Google Scholar 

  39. Thilen SR, Bhananker SM (2016) Qualitative neuromuscular monitoring: how to optimize the use of a peripheral nerve stimulator to reduce the risk of residual neuromuscular blockade. Curr Anesthesiol Rep 6:164–169

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sessler DI (2008) Perioperative thermoregulation. In: Silverstein JH, Rooke GA, Reves JG, McLeskey CH (eds) Geriatric anesthesiology, 2nd edn. New York, Springer, pp 107–122

    Chapter  Google Scholar 

  41. Finnerty CC, Mabvuure NT, Ali A et al (2013) The surgically induced stress response. J Parenter Enteral Nutr 37(Supp 1):21S–29S

    Article  Google Scholar 

  42. Paola A, Carlo L, Cinzia DR et al (2015) Stress response to surgery, anesthetics role and impact on cognition. J Anesth Clin Res 6:539–544

    Google Scholar 

  43. Rigg JR, Jamrozik K, Myles PS, Silbert BS et al (2002) Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 359(9314):1276–1282

    Article  PubMed  Google Scholar 

  44. Radtke FM, Franck M, Lendner J et al (2013) Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Brit J Anaesth 110(S1):i98–i105

    Article  CAS  PubMed  Google Scholar 

  45. Sieber FE, Zakriya KJ, Gottschalk A et al (2010) Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair. Mayo Clin Proc 85:18–26

    Article  PubMed  PubMed Central  Google Scholar 

  46. Walsh M, Devereaux PJ, Garg AX et al (2013) Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery. Anesthesiology 119:507–515

    Article  PubMed  Google Scholar 

  47. Bijker JB, Persoon S, Peelen LM et al (2012) Intraoperative hypotension and perioperative ischemic stroke after general surgery. A nested case-control study. Anesthesiology 116:658–664

    Article  PubMed  Google Scholar 

  48. Willingham MD, Karren E, Shanks AM et al (2015) Concurrence of intraoperative hypotension, low minimum alveolar concentration, and low bispectral index is associated with postoperative death. Anesthesiology 123:775–785

    Article  PubMed  PubMed Central  Google Scholar 

  49. Landesberg G, London MJ (2016) The enigma of postoperative troponin elevation. Anesth Analg 123:5–7

    Article  PubMed  Google Scholar 

  50. Ramakrishna H, Pagel PS (2016) Preoperative troponin in patients undergoing noncardiac surgery: is timing everything? Anesth Analg 123:2–4

    Article  PubMed  Google Scholar 

  51. Aurini L, White PF (2014) Anesthesia for the elderly outpatient. Curr Opin Anaesthesiol 27:563–575

    Article  CAS  PubMed  Google Scholar 

  52. Crossley L, Pentakota S (2016) Now is the time for paradigm shift in geriatric anesthesia. ASA Monitor 80:40–41

    Google Scholar 

  53. Murthy S, Hepner DL, Cooper Z, Bader AM, Neuman MD (2015) Controversies in anaesthesia for noncardiac surgery in older adults. Br J Anaesth 115(Suppl 2):ii15–ii25

    Article  PubMed  PubMed Central  Google Scholar 

  54. Schlitzkus LL, Melin AA, Johanning JM, Schenarts PJ (2015) Perioperative management of elderly patients. Surg Clin North Am 95:391–415

    Article  PubMed  Google Scholar 

  55. Moyce Z, Rodseth RN, Biccard BM (2014) The efficacy of peri-operative interventions to decrease postoperative delirium in non-cardiac surgery: a systematic review and meta-analysis. Anaesthesia 69:259–269

    Article  CAS  PubMed  Google Scholar 

  56. Vuyk J (2003) Pharmacodynamics in the elderly. Best Pract Res Clin Anaesthesiol 17:207–218

    Article  CAS  PubMed  Google Scholar 

  57. Aymanns C, Keller F, Maus S, Hartmann B, Czock D (2010) Review on pharmacokinetics and pharmacodynamics and the aging kidney. Clin J Am Soc Nephrol 5:314–327

    Article  CAS  PubMed  Google Scholar 

  58. Homer TD, Stanski DR (1985) The effect of increasing age on thiopental disposition and anesthetic requirement. Anesthesiology 62:714–724

    Article  CAS  PubMed  Google Scholar 

  59. White PF, White LM, Monk T, Jakobsson J, Raeder J, Mulroy MF, Bertini L, Torri G, Solca M, Pittoni G, Bettelli G (2012) Perioperative care for the older outpatient undergoing ambulatory surgery. Anesth Analg 114:1190–1215

    Article  PubMed  Google Scholar 

  60. Barnett SR (2009) Polypharmacy and perioperative medications in the elderly. Anesthesiol Clin 27:377–389, table of contents

    Article  PubMed  Google Scholar 

  61. Hussain M, Berger M, Eckenhoff RG, Seitz DP (2014) General anesthetic and the risk of dementia in elderly patients: current insights. Clin Interv Aging 9:1619–1628

    PubMed  PubMed Central  Google Scholar 

  62. McKeown JL (2015) Pain management issues for the geriatric surgical patient. Anesthesiol Clin 33:563–576

    Article  PubMed  Google Scholar 

  63. Antonelli M, Conti G, Moro ML, Esquinas A et al (2001) Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med 27:1718–1728

    Article  CAS  PubMed  Google Scholar 

  64. El Tumi H, Johnson MI, Dantas PB et al (2017) Age-related changes in pain sensitivity in healthy humans: a systematic review with meta-analysis. Eur J Pain 21(6):955–964

    Article  PubMed  Google Scholar 

  65. Gibson SJ, Farrell M (2004) A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain 20:227–239

    Article  PubMed  Google Scholar 

  66. Gibson SJ, Helme RD (2001) Age-related differences in pain perception and report. Clin Geriatr Med 17:433–456, v–vi

    Article  CAS  PubMed  Google Scholar 

  67. Lautenbacher S (2012) Experimental approaches in the study of pain in the elderly. Pain Med 13(Suppl 2):S44–S50

    Article  PubMed  Google Scholar 

  68. Schmucker DL (2005) Age-related changes in liver structure and function: implications for disease? Exp Gerontol 40:650–659

    Article  CAS  PubMed  Google Scholar 

  69. Gourtsoyiannis N, Prassopoulos P, Cavouras D, Pantelidis N (1990) The thickness of the renal parenchyma decreases with age: a CT study of 360 patients. AJR Am J Roentgenol 155:541–544

    Article  CAS  PubMed  Google Scholar 

  70. Epstein M (1996) Aging and the kidney. J Am Soc Nephrol 7:1106–1122

    CAS  PubMed  Google Scholar 

  71. Lindeman RD, Tobin J, Shock NW (1985) Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 33:278–285

    Article  CAS  PubMed  Google Scholar 

  72. Nyengaard JR, Bendtsen TF (1992) Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec 232:194–201

    Article  CAS  PubMed  Google Scholar 

  73. Beck LH (2000) The aging kidney. Defending a delicate balance of fluid and electrolytes. Geriatrics 55:26–8, 31–2

    CAS  PubMed  Google Scholar 

  74. Melk A (2003) Senescence of renal cells: molecular basis and clinical implications. Nephrol Dial Transplant 18:2474–2478

    Article  CAS  PubMed  Google Scholar 

  75. Schlanger LE, Bailey JL, Sands JM (2010) Electrolytes in the aging. Adv Chronic Kidney Dis 17:308–319

    Article  PubMed  PubMed Central  Google Scholar 

  76. Desborough JP (2000) The stress response to trauma and surgery. Br J Anaesth 85:109–117

    Article  CAS  PubMed  Google Scholar 

  77. Spechler SJ (1992) Epidemiology and natural history of gastro-oesophageal reflux disease. Digestion 51(Suppl 1):24–29

    PubMed  Google Scholar 

  78. Perez-Perez GI, Dworkin BM, Chodos JE, Blaser MJ (1988) Campylobacter pylori antibodies in humans. Ann Intern Med 109:11–17

    Article  CAS  PubMed  Google Scholar 

  79. Whitehead WE, Drinkwater D, Cheskin LJ et al (1989) Constipation in the elderly living at home. Definition, prevalence, and relationship to lifestyle and health status. J Am Geriatr Soc 37:423–429

    Article  CAS  PubMed  Google Scholar 

  80. Wilson JA (1999) Constipation in the elderly. Clin Geriatr Med 15:499–510

    CAS  PubMed  Google Scholar 

  81. Freston JW (1990) Overview of medical therapy of peptic ulcer disease. Gastroenterol Clin N Am 19:121–140

    CAS  Google Scholar 

  82. Rees WD (1991) Mechanisms of gastroduodenal protection by sucralfate. Am J Med 91:58S–63S

    Article  CAS  PubMed  Google Scholar 

  83. Scheiman JM (1992) Pathogenesis of gastroduodenal injury due to nonsteroidal antiinflammatory drugs: implications for prevention and therapy. Semin Arthritis Rheum 21:201–210

    Article  CAS  PubMed  Google Scholar 

  84. Walt RP, Langman MJ (1991) Antacids and ulcer healing. A review of the evidence. Drugs 42:205–212

    Article  CAS  PubMed  Google Scholar 

  85. Alzubaidi M, Gabbard S (2015) GERD: diagnosing and treating the burn. Cleve Clin J Med 82:685–692

    Article  PubMed  Google Scholar 

  86. Chou R, Gordon DB, de Leon-Casasola OA et al (2016) Management of postoperative pain: a clinical practice guideline from the American pain society, the American society of regional anesthesia and pain medicine, and the American society of anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council. J Pain 17:131–157

    Article  PubMed  Google Scholar 

  87. Grifasi C, Calogero A, Esposito A, Dodaro C (2014) Perioperative care of elderly outpatient: a review. Ann Ital Chir 85:1–6

    Google Scholar 

  88. Sadean MR, Glass PS (2003) Pharmacokinetics in the elderly. Best Pract Res Clin Anaesthesiol 17:191–205

    Article  CAS  PubMed  Google Scholar 

  89. White PF, Kehlet H (2010) Improving postoperative pain management: what are the unresolved issues? Anesthesiology 112:220–225

    Article  PubMed  Google Scholar 

  90. Elvir-Lazo OL, White PF (2010) The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol 23:697–703

    Article  PubMed  Google Scholar 

  91. Elvir-Lazo OL, White PF (2010) Postoperative pain management after ambulatory surgery: role of multimodal analgesia. Anesthesiol Clin 28:217–224

    Article  PubMed  Google Scholar 

  92. Warren-Stomberg M, Brattwall M, Jakobsson JG (2013) Non-opioid analgesics for pain management following ambulatory surgery: a review. Minerva Anestesiol 79:1077–1087

    CAS  PubMed  Google Scholar 

  93. Soleimanpour H, Safari S, Shahsavari Nia K et al (2016) Opioid drugs in patients with liver disease: a systematic review. Hepat Mon 16:e32636

    PubMed  PubMed Central  Google Scholar 

  94. Murphy EJ (2005) Acute pain management pharmacology for the patient with concurrent renal or hepatic disease. Anaesth Intensive Care 33:311–322

    CAS  PubMed  Google Scholar 

  95. Dean M (2004) Opioids in renal failure and dialysis patients. J Pain Symptom Manag 28:497–504

    Article  CAS  Google Scholar 

  96. Perlman R, Giladi H, Brecht K, Ware MA, Hebert TE, Joseph L, Shir Y (2013) Intradialytic clearance of opioids: methadone versus hydromorphone. Pain 154:2794–2800

    Article  CAS  PubMed  Google Scholar 

  97. Tegeder I, Lotsch J, Geisslinger G (1999) Pharmacokinetics of opioids in liver disease. Clin Pharmacokinet 37:17–40

    Article  CAS  PubMed  Google Scholar 

  98. Sunderland S, Yarnold CH, Head SJ et al (2016) Regional versus general anesthesia and the incidence of unplanned health care resource utilization for postoperative pain after wrist fracture surgery: results from a retrospective quality improvement project. Reg Anesth Pain Med 41:22–27

    Article  CAS  PubMed  Google Scholar 

  99. Brattwall M, Jildenstal P, Warren Stomberg M, Jakobsson JG (2016) Upper extremity nerve block: how can benefit, duration, and safety be improved? An update [version 1; referees: 3 approved]. F1000Res 5(F1000 Faculty Rev):907 (doi:10.12688/f1000research.7292.1)

    Google Scholar 

  100. Huynh TM, Marret E, Bonnet F (2015) Combination of dexamethasone and local anaesthetic solution in peripheral nerve blocks: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol 32:751–758

    Article  CAS  PubMed  Google Scholar 

  101. Kandasami M, Kinninmonth AW, Sarungi M, Baines J, Scott NB (2009) Femoral nerve block for total knee replacement – a word of caution. Knee 16:98–100

    Article  PubMed  Google Scholar 

  102. Ilfeld BM, Duke KB, Donohue MC (2010) The association between lower extremity continuous peripheral nerve blocks and patient falls after knee and hip arthroplasty. Anesth Analg 111:1552–1554

    Article  PubMed  PubMed Central  Google Scholar 

  103. Critchley LA (1996) Hypotension, subarachnoid block and the elderly patient. Anaesthesia 51:1139–1143

    Article  CAS  PubMed  Google Scholar 

  104. Gustafsson LL, Schildt B, Jacobsen K (1982) Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden. Br J Anaesth 54:479–486

    Article  CAS  PubMed  Google Scholar 

  105. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC

    Google Scholar 

  106. Bitsch MS, Foss NB, Kristensen BB, Kehlet H (2006) Acute cognitive dysfunction after hip fracture: frequency and risk factors in an optimized, multimodal, rehabilitation program. Acta Anaesthesiol Scand 50:428–436

    Article  CAS  PubMed  Google Scholar 

  107. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710

    Article  CAS  PubMed  Google Scholar 

  108. Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH (1998) The association of intraoperative factors with the development of postoperative delirium. Am J Med 105:380–384

    Article  CAS  PubMed  Google Scholar 

  109. Marcantonio ER, Goldman L, Mangione CM et al (1994) A clinical prediction rule for delirium after elective noncardiac surgery. JAMA 271:134–139

    Article  CAS  PubMed  Google Scholar 

  110. Witlox J, Eurelings LS, de Jonghe JF et al (2010) Delirium in elderly patients and the risk of post-discharge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451

    Article  CAS  PubMed  Google Scholar 

  111. Siddiqi N, Stockdale R, Britton AM, Holmes J (2007) Interventions for preventing delirium in hospitalised patients. Cochrane Database Syst Rev, Issue 2. Art. No.: CD005563. doi:10.1002/14651858.CD005563.pub2.

    Google Scholar 

  112. Clegg A, Siddiqi N, Heaven A, Young J, Holt R (2014) Interventions for preventing delirium in older people in institutional long-term care. Cochrane Database Syst Rev, Issue 1. Art. No.: CD009537. doi:10.1002/14651858.CD009537.pub2.

    Google Scholar 

  113. Carnes M, Howell T, Rosenberg M, Francis J et al (2003) Physicians vary in approaches to the clinical management of delirium. J Am Geriatr Soc 51:234–239

    Article  PubMed  Google Scholar 

  114. Kalisvaart KJ, de Jonghe JF, Bogaards MJ et al (2005) Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 53:1658–1666

    Article  PubMed  Google Scholar 

  115. Larsen KA, Kelly SE, Stern TA et al (2010) Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics 51:409–418

    Article  CAS  PubMed  Google Scholar 

  116. Gamberini M, Bolliger D, Lurati Buse GA et al (2009) Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery – a randomized controlled trial. Crit Care Med 37:1762–1768

    Article  CAS  PubMed  Google Scholar 

  117. Sampson EL, Raven PR, Ndhlovu PN et al (2007) A randomized, double-blind, placebo-controlled trial of donepezil hydrochloride (Aricept) for reducing the incidence of postoperative delirium after elective total hip replacement. Int J Geriatr Psychiatry 22:343–349

    Article  PubMed  Google Scholar 

  118. Terrando N, Brzezinski M, Degos V et al (2011) Perioperative cognitive decline in the aging population. Mayo Clin Proc 86:885–893

    Article  PubMed  PubMed Central  Google Scholar 

  119. Newman S, Stygall J, Hirani S et al (2007) Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology 106:572–590

    Article  PubMed  Google Scholar 

  120. Moller JT, Cluitmans P, Rasmussen LS et al (1998) Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators international study of post-operative cognitive dysfunction. Lancet 351:857–861

    Article  CAS  PubMed  Google Scholar 

  121. Maze M, Todd MM (2007) Special issue on postoperative cognitive dysfunction: selected reports from the journal-sponsored symposium. Anesthesiology 106:418–420

    Article  PubMed  Google Scholar 

  122. Monk TG, Weldon BC, Garvan CW, Dede DE, van der Aa MT, Heilman KM, Gravenstein JS (2008) Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 108:18–30

    Article  PubMed  Google Scholar 

  123. Steinmetz J, Christensen KB, Lund T, Lohse N, Rasmussen LS (2009) Long-term consequences of postoperative cognitive dysfunction. Anesthesiology 110:548–555

    Article  PubMed  Google Scholar 

  124. Jackman NA, Lewis MC, Brzezinski M (2016) A pragmatic update on postoperative cognitive dysfunction. ASA Monitor 80:54–56

    Google Scholar 

  125. Evered L, Scott DA, Silbert B, Maruff P (2011) Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg 112:1179–1185

    Article  PubMed  Google Scholar 

  126. Guay J (2011) General anaesthesia does not contribute to long-term post-operative cognitive dysfunction in adults: a meta-analysis. Indian J Anaesth 55:358–363

    Article  PubMed  PubMed Central  Google Scholar 

  127. Harris RA, Eger EI 2nd (2008) Alzheimer’s disease and anesthesia: out of body, out of mind…or not? Ann Neurol 64:595–597

    Article  PubMed  Google Scholar 

  128. Mason SE, Noel-Storr A, Ritchie CW (2010) The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis. J Alzheimer’s Dis: JAD 22(Suppl 3):67–79

    Article  Google Scholar 

  129. Silbert BS, Evered LA, Scott DA (2014) Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy. Br J Anaesth 113:784–791

    Article  CAS  PubMed  Google Scholar 

  130. Czernicki M, Kukreja J, Motraghi T et al (2012) Volatile anesthetics: neuroprotective or neurodamaging? J Anesthe Clinic Res 3:e104. doi:10.4172/2155–6148.1000e104

    Article  Google Scholar 

  131. Steinmetz J, Siersma V, Kessing LV, Rasmussen LS, Group I (2013) Is postoperative cognitive dysfunction a risk factor for dementia? A cohort follow-up study. Br J Anaesth 110(Suppl 1):i92–i97

    Article  PubMed  Google Scholar 

  132. Seitz DP, Reimer CL, Siddiqui N (2013) A review of epidemiological evidence for general anesthesia as a risk factor for Alzheimer’s disease. Prog Neuro-Psychopharmacol Biol Psychiatry 47:122–127

    Article  CAS  Google Scholar 

  133. Hauck JN, Terrando N, Kukreja J, Brzezinski M (2012) Does general anesthesia promote Alzheimer’s disease? J Anesthe Clinic Res 3:193. doi:10.4172/2155-6148.1000193

    Google Scholar 

  134. Schaller SJ, Anstey M, Blobner M et al (2016) International early S-gMRI. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 388:1377–1388

    Article  PubMed  Google Scholar 

  135. Investigators TS, Hodgson C, Bellomo R et al (2015) Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 19:81

    Article  Google Scholar 

  136. Hodgson CL, Berney S, Harrold M et al (2013) Clinical review: early patient mobilization in the ICU. Crit Care 17:207

    Article  PubMed  PubMed Central  Google Scholar 

  137. Boelens PG, Heesakkers FF, Luyer MD et al (2014) Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: prospective, randomized, controlled trial. Ann Surg 259:649–655

    Article  PubMed  Google Scholar 

  138. Doig GS, Simpson F, Sweetman EA et al (2013) Early PNIotACTG. Early parenteral nutrition in critically ill patients with short-term relative contraindications to early enteral nutrition: a randomized controlled trial. JAMA 309:2130–2138

    Article  CAS  PubMed  Google Scholar 

  139. Ochoa Gautier JB, Machado FR (2013) Early nutrition in critically ill patients: feed carefully and in moderation. JAMA 309:2165–2166

    Article  CAS  PubMed  Google Scholar 

  140. Deiner S, Silverstein JH (2012) Long-term outcomes in elderly surgical patients. Mt Sinai J Med 79:95–106

    Article  PubMed  PubMed Central  Google Scholar 

  141. Thomas DR, Ritchie CS (1995) Preoperative assessment of older adults. J Am Geriatr Soc 43:811–821

    Article  CAS  PubMed  Google Scholar 

  142. Barlow AP, Zarifa Z, Shillito RG et al (1989) Surgery in a geriatric population. Ann R Coll Surg Engl 71:110–114

    CAS  PubMed  PubMed Central  Google Scholar 

  143. Dekker JW, van den Broek CB, Bastiaannet E et al (2011) Importance of the first postoperative year in the prognosis of elderly colorectal cancer patients. Ann Surg Oncol 18:1533–1539

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  144. Hosking MP, Warner MA, Lobdell CM et al (1989) 3rd. Outcomes of surgery in patients 90 years of age and older. JAMA 261:1909–1915

    Article  CAS  PubMed  Google Scholar 

  145. Keller SM, Markovitz LJ, Wilder JR, Aufses AH Jr (1987) Emergency and elective surgery in patients over age 70. Am Surg 53:636–640

    CAS  PubMed  Google Scholar 

  146. Fitzgerald JF, Moore PS, Dittus RS (1988) The care of elderly patients with hip fracture. Changes since implementation of the prospective payment system. N Engl J Med 319:1392–1397.

    Google Scholar 

  147. Kemper P, Murtaugh CM (1991) Lifetime use of nursing home care. N Engl J Med 324:595–600

    Google Scholar 

  148. Lamont CT, Sampson S, Matthias R, Kane R (1983) The outcome of hospitalization for acute illness in the elderly. J Am Geriatr Soc 31:282–288

    Article  CAS  PubMed  Google Scholar 

  149. Sloane PD, Pickard CG (1985) Custodial nursing home care. Setting realistic goals. J Am Geriatr Soc 33:864–868

    Article  CAS  PubMed  Google Scholar 

  150. Institute of Healthcare Improvement: Triple Aim Initiative. Available from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx. Accessed 10 Mar 2017

  151. American Society of Anesthesiology. Perioperative Surgical Home. Available from https://www.asahq.org/psh. Accessed 10 Mar 2017

  152. Garson L, Schwarzkopf R, Vakharia S et al (2014) Implementation of a total joint replacement-focused perioperative surgical home: a management case report. Anesth Analg 118:1081

    Article  PubMed  Google Scholar 

  153. Mello MT, Azocar RJ, Lewis MC (2015) Geriatrics and the perioperative surgical home. Anesthesiol Clin 33:439–445

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA

    Marek Brzezinski

  2. Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St., Box 356540, Seattle, WA, 98195-6540, USA

    G. Alec Rooke

  3. Department of Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, MA, USA

    Ruben J. Azocar

Authors
  1. Marek Brzezinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Alec Rooke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruben J. Azocar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruben J. Azocar .

Editor information

Editors and Affiliations

  1. Surgical Service, Yale University School of Medicine VA Connecticut Health Care System, West Haven, Connecticut, USA

    Ronnie A. Rosenthal

  2. SUNY Downstate School of Public Health, National Capital Region Johns Hopkins Medicine, Bethesda, Maryland, USA

    Michael E. Zenilman

  3. Center for Geriatric Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland, USA

    Mark R. Katlic

Section Editor information

  1. School of Medicine, Department of Surgery, University of Colorado, Anschutz Medical Campus, 12631 E 17th Ave, MS C313, 80045, Aurora, CO, USA

    Thomas Robinson

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this entry

Cite this entry

Brzezinski, M., Rooke, G.A., Azocar, R.J. (2017). Anesthetic Management. In: Rosenthal, R., Zenilman, M., Katlic, M. (eds) Principles and Practice of Geriatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20317-1_72-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-20317-1_72-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20317-1

  • Online ISBN: 978-3-319-20317-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation