Postanesthesia Care for the Elderly Patient

García, Paul S.; Duggan, Elizabeth W.; McCullough, Ian; Lee, Simon J. Craddock; Fishman, David A.

doi:10.1016/j.clinthera.2015.10.018

Cited by 11 publications

(11 citation statements)

References 114 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although younger age (< 50 years) is a primary risk factor for PONV, surgical factors and anesthetic techniques increase the risk, even in low-risk populations. In addition, approximately 15% of older patients are affected by dysphagia, and this may increase to 50% in those with neurologic disease; PONV in older patients with postoperative dysphagia can increase the risk of aspiration pneumonia [150].…”

Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

View full text Add to dashboard Cite

Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions.

show abstract

Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Here, we introduce the capability of infrared pupillometry to screen for patients with PACU-D. Patients undergoing general anesthesia are at risk for several potential adverse outcomes in the PACU besides PACU-D [11,12] such as breathing difficulties [13], arrhythmias [14], pain [15], and postoperative nausea/ vomiting [16]. The published guidelines for post anesthesia care recommend several standard monitors intended to quickly identify potential acute postoperative cardiac or respiratory issues [17].…”

Section: Introductionmentioning

confidence: 99%

Infrared pupillometry helps to detect and predict delirium in the post-anesthesia care unit

Yang

Kreuzer

Hesse

et al. 2017

J Clin Monit Comput

Self Cite

View full text Add to dashboard Cite

This study evaluates the capability of pupillary parameters to detect and predict delirium in the post-anesthesia care unit (PACU-D) following general anesthesia. PACU-D may complicate and prolong the patient's postoperative course, consequently increasing hospital costs. After institutional approval, 47 patients undergoing surgical interventions with general anesthesia were included in the study. We measured the pupillary reflexes at signing of informed consent, during surgery 20 min after intubation and when the primary inhaled anesthetic was turned off, and 15 and 45 min after PACU admittance and upon discharge from the PACU. We evaluated patients for delirium using the confusion assessment method for the intensive care unit (CAM-ICU) score after 15 and 60 min in the PACU. We chose receiver operating curve (ROC) and area under the curve (AUC) to compare the performance of non-pupillary parameters to pupillary parameters, such as pupil diameter, percent constriction, and dilation velocity, to detect and predict PACU-D. Percent constriction (AUC = 0.93, optimal threshold = 18.5%) and dilation velocity (AUC = 0.93, optimal threshold = 0.35 mm/s) showed excellent ability to detect and predict delirium persisting throughout the PACU stay. These pupillary measures showed superior performance compared to other pupillary measures and features commonly associated with delirium, e.g., age (AUC = 0.73), total opioids (AUC = 0.56), or length of surgery (AUC = 0.40). Our results suggest that pupillometry and the parameters derived from the recording may identify delirious patients in the PACU. This information can help to efficiently structure their care in a timely manner, and potentially avoid adverse complications for the patient and financial consequences for the hospital.

show abstract

“…Hence, it can attenuate the body in how it interacts with the anesthetics and frequently used medications in anesthesia practice. [ 22 ] The elderly showed an adverse event threshold effect at a lower drug concentration than young people, demonstrating a difference in reaction to CNS-active medications between young and old people. [ 9 ]…”

Section: Common Postoperative Complications Of Elderly Patientsmentioning

confidence: 99%

The elderly in the post-anesthesia care unit

Alghamdi,

Almuzayyen,

Chowdhury

2023

Saudi J Anaesth

View full text Add to dashboard Cite

It is increasingly conceivable that elderly patients will be treated in perioperative settings as the world’s population shifts toward an older age distribution. They are more prone to a variety of unfavorable outcomes as a consequence of the physiological changes that accompany aging and the coexistence of multiple medical conditions. Postoperative complications in elderly patients are linked to a large increase in morbidity and mortality and the burden placed on the healthcare system. Our goal is to determine how elderly patients’ recovery after anesthesia differs from that of younger patients. In addition, we will discuss the main postoperative complications experienced by elderly patients and the measures that are utilized to limit the risk of these complications developing.

show abstract

Postanesthesia Care for the Elderly Patient

Abstract: Before surgery, it is essential to identify those patients at risk for delirium and other commonly encountered postanesthesia scenarios. Failure to manage these conditions appropriately can lead to an escalation of care and prolonged hospitalization.

Cited by 11 publications

References 114 publications

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Infrared pupillometry helps to detect and predict delirium in the post-anesthesia care unit

The elderly in the post-anesthesia care unit

Contact Info

Product

Resources

About