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ANESTHESIA ALERT
and even minor cases may require more aggressive treatment with
vasopressors. Patients with heart conditions are already in danger of
not getting enough blood or oxygen flow, so the effects can be detrimental. As with those carrying neurological risks, your patients with
cardiac disease will also not be able to tolerate decreases in blood
pressure very well. Hypotension can then lead to ischemia with consequent infarction, arrhythmias and congestive heart failure.
Other areas of impact
Oxygen uptake from the lungs becomes less efficient and results in a
lower oxygen saturation and blood-oxygen partial pressure. Elderly
patients are more sensitive to anesthetic agents and less capable of
clearing secretions because of the impairment of hypercapneic and
hypoxic respiratory responses, respiratory muscle strength/cough, vital
capacity and ciliary function. This also has a possibility of delaying
extubation. What does that mean? Your patients may require supplemental oxygen for longer periods in the recovery room. There is also an
increased incidence of respiratory failure from co-existing diseases like
COPD and left ventricular failure.
Your patients' renal functions can take a hit due to atrophy of afferent and efferent arterioles, atherosclerosis and comorbid disease. This
means a decrease in renal mass, renal blood flow, creatinine clearance
and glomerular filtration. The result can be a decrease in drug clearance and impaired fluid balance for which you'll need to account.
Because the kidneys aren't clearing well, there is likely to be a prolonged effect of drugs. If you give the patient a drug that can be toxic,
she's going to take an even bigger hit. Additionally, the kidneys may
not be able to tolerate hypotension, meaning pre-existing renal function in your elderly patients can worsen.
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U N E 2013
