Professional Documents
Culture Documents
Aging population
Increased number of
older surgical patients
Total (>65 years) : 34%
Why are they so special?
Comorbid illness
Silverstein JH, Rooke GA, Reves JG, McLeskey CH. Geriatric Anesthesiology. 2nd Ed. Springer, 2008.
Prospective cohort of 372 elderly patients
MMSE - 3 weeks
IADL - 6 months
Control of Perioperative Pathophysiology
a ch
p ro
Patient Surgical
p
Non-Opioid
a
Physical Enteral
d
Information Stress Pain Relief Activity Nutrition
il s e
o n a
e rs Postoperative Physical Capacity
P
Morbidity and Rehabilitation Needs
Not all elderly are the same
Preoperative Assessment
Comprehensive and transdisciplinary
Risk assessment
Failure of coordination
Patel KV, Brennan KL, Davis ML. Association of a modified frailty index with mortality after femoral neck fracture in patients aged
60 years and old. Clin Orthop Relat Res. 2014;472(3):1010-7.
Prehabilitation
Method of enhancing the
functional capacity of a patient
Goals : to prevent
deconditioning and improve
the ability of the patient to
withstand the stressors of
surgery
Carli F, Bousquet-Dion G. Improving perioperative functional capacity : a case for prehabilitation. Geriatr Anesthesiol. 2017:73-84.
Temperature Control
Impaired thermoregulation
Wh
pat ile I
ient a mc
as s sho o
Anesthesia and surgical environment
col u o l ,
d a d no l
sI t
am be
Perioperative hypothermia persists …
longer
Transdisciplinary approach
for the best outcome
“A patient’s age should be treated as a scientific fact, not with
prejudice. No particular chronologic age, of itself, is a
contraindication to operation.”
In : Rosenthal RA, Zenilman ME, Katlic MR, editors. Principles and practice of geriatric
surgery. New York (NY): Springer; 2001. Principles of geriatric surgery; pp. 92–104
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