Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia

Abstract

Introduction: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. Methods: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities. Results: Especially in combination with advanced age, the effects of malignancies can be devastating, bringing new health challenges, exacerbating preexisting conditions, and exerting severe psychological strain. An interdisciplinary assessment and process planning provide an ideal setting to identify and prevent potential complications, especially in regards to frailty and cardiovascular risk. In addition, important perioperative considerations are presented, such as malnutrition, fasting, intraoperative neuromonitoring, and hemodynamic control, as well as postoperative early mobilization, pain, and delirium management. Conclusion: The decisions and interventions made in the perioperative stage can positively influence many intra- and postoperative factors, significantly improving the chances of successful treatment of elderly cancer patients. Appropriate management can help prevent or mitigate complications, secure a quick recovery, and improve short- and long-term outcomes.

Correlation of carotid corrected flow time and respirophasic variation in blood flow peak velocity with stroke volume variation in elderly patients under general anaesthesia

“…The perioperative management of elderly patients is challenging for anaesthesiologists due to the functional decline of various organ systems and comorbidities; therefore, fluid management is critical [ 1 ]. Fluid overload can cause complications such as pulmonary oedema, heart failure, and acute kidney injury, while insufficient fluid resuscitation can exacerbate organ ischaemia and hypoxia, resulting in a poor prognosis [ 2 , 3 ].…”

Considerations in Geriatric Anesthesia - An overview

“…Careful titration of drugs is also essential. 48 Lower dosages are required for propofol, remifentanil and ropivacaine. Adequate titration of desflurane is advisable .Special attention should be given to hypnotic agents, as the dose requirement is much lower and the drugs can have prolonged duration of action.…”

The physiologic responses to a fluid bolus administration in old and young healthy adults

“…This is related to a decline in organ function and age-related maldistribution of electrolytes (Luckey and Parsa 2003 ; Schlanger et al 2010 ). Therefore, large volume fluid replacement therapy must be carefully approached in older patients because fluid mismanagement can lead to organ dysfunction and death (Brandstrup et al 2003 ; Nisanevich et al 2005 ; Mörgeli et al 2017 ; Ko et al 2019 ). Despite numerous advances to preoperatively optimize patients to undergo surgery (Mangano et al 1996 ; Poldermans et al 2001 ), older adults remain at an increased risk for complications of excess fluid (Arieff 1999 ; Harris et al 2018 ; Klein et al 2007 ; Miller and Myles 2019 ).…”