DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Anaesthetic Management of Elderly PatientsMd Rabiul Alam
The Scopes of the presentations are: Anaesthetic definition of elderly & workload, Brief on age-related changes, Importance of good anaesthetic evaluation, Practice of functional reserve/capacity assessment, Morbidity and Mortality, Decision of Surgery & Planning of Anaesthesia & Perioperative management in nutshell.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Anaesthetic Management of Elderly PatientsMd Rabiul Alam
The Scopes of the presentations are: Anaesthetic definition of elderly & workload, Brief on age-related changes, Importance of good anaesthetic evaluation, Practice of functional reserve/capacity assessment, Morbidity and Mortality, Decision of Surgery & Planning of Anaesthesia & Perioperative management in nutshell.
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
as the life expectancy has increased. more and more elderly patients are undergoing surgery. the burden of postoperative dysfunction has to be increased in future. There should be attempt to identify the risk factors and measures to prevent POCD.
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Geriatric anesthesia with special consideration Petrus IitulaPetrus Iitula
With age, comes changes in normal physiological functions of the body and different diseases are picked up in certain population groups as we age. all this factors predisposes the geriatric population to certain complications once under anesthesia. Hence anesthetic preparation for the geriatric patients is needed to avoid mortality and morbidity in this population.
Basics of Shock and its management. Compentency and SLO based learning for undergraduate medical training (MBBS)
Check out the lecture by clicking on the link below
https://www.youtube.com/watch?v=J5m4kh4FO7k
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
Physiological changes during pregnancy
Systemic changes
Renal changes
Renal function
Tubular function
Plasma osmolality
Anatomical changes
AKI during pregnancy
Pre-renal causes
Renal causes
Post-renal causes
Investigations
Management
Similar to Geriatric anesthesia physiological changes and preoperative preparation (20)
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Lecture outline
Introduction
Normal physiological changes associated
with ageing and its Anaesthesia
Implication
Pre-operative Assessment
Pharmacokinetics and Pharmacodynamics
in the elderly
Take Home Message
tmc 2
3. Who are Geriatric Patients
Most of the world countries have
accepted the chronological age of 65
and more as a definition of geriatric
patients ( Three Groups)
Elderly ------ Age 65 to 74
Aged -------- Age 75 to 84
Very Old ---- Age 85 and more
Old age is not a disease
tmc 3
5. Realities for the geriatric patients in Health
* In India around 200 millions (15 %) people are > 65 years
* They account for almost half of hospital care days
* 25-35% surgical cases and procedures done on this age group
* Life expectancy in India now 70-72 yrs
* Medical diseases are most common in this group
* Demographical data indicate the elderly people are most
rapidly growing in population
• Use of health care services by elderly disproportionately
higher than younger patients
• The mortality rates for patients aged 80-84 is 3 %, 85-90 is 6 %
and above 90 year is 10 % in major surgeries
But all geriatric patients are not created equal !
tmc 5
6. tmc 6
Guinness Book of World Records
( Anesthesia given to Oldest Patient)
Laurie Randall
Age -102 years
Surgery – Revision of Hip Replacement
Anesthesia – Epidural
Duration – 2 Hours
Pinderfields Hospital in Wakefield, West Yorks, UK
2 February 2012
7. Age-Related Physiological Changes
Three Groups of Physiological
Changes
1) Changes in autonomic
functions and cellular
homeostasis e.g.
temperature, blood volumes
and Endocrine changes
2) Reduction in organic mass
e.g. brain, liver, kidneys,
bones and muscles
3) Reduction in organic
functional reserve e.g. lungs
and heart
Systems Affected
• Cardiovascular system
• Respiratory System
• Genitourinary System
• Gastrointestinal System
• Endocrine System
• Skin and Musculoskeletal
System
• Nervous System
• Body temperature regulation
• Immune System
• Psychological Changes
tmc 7
9. Cardio-Vascular Changes
• Heart – Cardiac output Decrease 1 % per year after 30 years
of age (at 80 year age CO is half that of a 20 year old person)
• Blood Pressure – BP increase 1 mm of hg every year after 50
years as a normal consequence of aging. Systolic will increase
and Diastolic remains unchanged or increase. ( Who data
says around 50 % are Hypertensive in geriatric age group )
• Arteriosclerosis and Coronary Artery Disease
Thickening of arterial walls and Loss of elasticity
Loss of SA node cells causing slowed conduction
Myocytes death without replacement leading to increase risk
of myocardial infarction
• Decreased response to beta-receptor stimulation
• ECG Slightly increased PR, QRS and Q-T intervals
tmc 9
10. Changes and its Effects
Changes
• Arterial wall thickening, stiffening
& decrease compliance
• Left ventricular and atrial
Hypertrophy
• Sclerosis of atrial and mitral
valves
• Decrease Beta adrenergic
response
• Decrease baroreceptor sensitivity
• Decrease SA node automaticity
• Diastolic Dysfunction
Effects
• Decrease exercise tolerance
leading to easy fatigability
• Coronary artery Disease
• Congestive Heart failure
• Risk of arrhythmias
• Diminished peripheral pulse
and cold extremities
• Increased blood pressure
• Postural Hypotension
tmc 10
11. tmc 11
Thickened arterial wall
Narrow lumen
Sclerosis of atrial and
mitral valves
SA node
Dysfunction
Increased Stiffness and Endothelial Dysfunction
arrhythmia
Diastolic
Dysfunction
12. Anaesthesia Implication
• Hypotension and Bradycardia should be kept in
mind during induction
• For emergency Anesthesia BP up to 180/110
mm of hg should be allowed
• Heart Rate up to 50 at rest is allowed for induction
• Minor ECG changes are not threatening for
anesthesia induction
• Ejection Fraction up to 45 % is normal for geriatric
age group without any symptoms
• Use of Beta blockers and Anti platelets in pre
operative period gives more cardio stability in
old heart
Remember old heart can not compensate decrease CO or increase heart rates
tmc 12
16. tmc 16
Reduced gas Exchange
Increase Wall Rupture
Alveolar Size increase
Alveolar changes in Older Lungs
17. Changes and its effects
Changes
• Decrease respiratory muscle
strength and elasticity
• Stiffer chest wall, AP diameter
increase
• In alveolar oxygen, no change
• In arterial oxygen, progressive
decrease
• Ventilation perfusion
mismatch
• Every year, 25 ml of decreased
VC and 25 ml increased RV
after 20 years of age
Effects
• Functional capacity declines
• Decrease cough reflex and
airway ciliary action
• Frequent airway collapse
• Reduced Compliance
• Snoring and Sleep apnea
common
• Higher chances of aspiration
• Increased risk of infection and
bronchospasm with airway
obstruction
tmc 17
18. Anesthetic Implications
• Advice to stop smoking at least 2 weeks
before planned surgery and anesthesia
• Proper Antibiotic & Anti-aspiration prophylaxis
• Educate older people for deep breathing and
coughing reflex preoperatively
• Oxygen-Oxygen-Oxygen therapy in Pre-Intra-
Post anesthesia period
• Avoid or reduce doses of Opoids
tmc 18
20. Genitourinary System Changes
Kidneys
--Gradual decrease in volume and weight of kidneys with aging
--Renal blood flow decrease, GFR decrease
--Decrease in total glomeruli leading to age related decrease in
creatinine clearance (no change in serum creatinine with advance age )
--Age related increase in blood urea nitrogen
Bladder
--Urinary incontinence found in almost 20 % population more than 65
years
--Capacity of bladder decrease & late sensation leading to overflow
incontinence
Prostate
--Enlargement of prostate in 90% male more then 65 years age, but only
10 % have symptomatic hyperplasia require surgery
tmc 20
21. Anesthesia Implication
• Age related Renal changes interferes with the excretion
of anesthesia drugs
• Because of bladder and prostatic changes urinary
catheterization is prime importance in major
anesthesia and surgery
• Renal insufficiency, dehydration and renal failure
common in elderly, so prompt actions to be taken
• Geriatric patients allowed clear fluid at least two
hours before anesthesia
tmc 21
23. Gastrointestinal System Changes
Esophagus --Decrease in strength of muscles of mastication, taste and thirst
--Presbyesophagus ( disturbances of esophageal activity )
--Decrease peristaltic movement & delayed transit time
leading to dysphagia
--Relaxed lower sphincter leading to chances of aspiration
Stomach
--Atrophic gastritis , which increase with age
--Increase heart burn in because of chronic
enterogastric bile reflux
Colon
--Decrease in colonic motility leading to constipation and
increase storage capacity
--Laxative abuse is very common
Liver and Billiary Tract
-- Decrease in liver weight and blood flow by 20 %, but no change in
Liver Function Tests
--Catalytic enzymes activity decrease
--Synthesis of protein binding and coagulation factors decreases
-- Drug metabolism is slow in old age group
-- Billiary tract disease are common
tmc 23
24. Anesthetic Implications
• Correct Fluid, Electrolytes and Nutritional
imbalance accordingly because of GUT changes
• Increased risk of gastric aspiration(PPI cover) and
NSAID induce ulcers (avoid)
• Keep in mind about constipation & complain of
constant abdominal disturbance Post-Op
• Decrease metabolism of anesthesia drugs and
risk of adverse drug reactions because of liver
changes
tmc 24
26. Endocrine System Changes
Pancreas (Glucose Homeostasis)
--Progressive deterioration in the number and function of
beta cells, but no decline in Insulin level
-- The average fasting glucose level rises 6 to 14 mg/dL
for each 10 years after age 50.
--Decrease glucose tolerance
Thyroid --Tendency for hypothyroidism
-- No change in Thyroid Function Tests
Parathyroid Gland
--No atrophy of Gland, but some fat deposition
--After 40 years PTH level in women increase leading to
bone loss problems (calcium and vitamin D reduction)
Adrenal glands
--No atrophy, but increase fibrous tissue
--Secretions of adrenal medulla increase(psychosomatic dz)
tmc 26
27. Anesthesia Implication
• Hyperglycemia increase the mortality and
morbidity in old age , because of late diagnose of
DM
Hyperglycemia and Hypoglycemia both not
tolerated
• Accepted level of FBS is between 80 – 120 mg/dl
or HbA1C less than 7 (always ask for HbA1C)
• Discontinue metformine and sulfonyl ureas night
before and day of surgery( due to increase
chance of MI in hypovolemic and reserved
cardiac functions in old age)
tmc 27
28. Skin and Musculoskeletal System Changes
Skin --Epidermis : Atrophy around face, neck, chest and extensor surface
of limbs
--Because of epidermis loss, prone for decubitus ulcers
--Dermis : Skin loses its elasticity resulting wrinkling and sagging of
sagging of skin
--Decreased sensitivity to pain and pressure
Skeletal
--Degenerative Joint Diseases causing disability
--Pain response is severe
--30 % Muscle mass reduced leading to decrease peripheral
metabolism of drugs, Low BMR due to weight loss
--Adipose tissue increase gradually
--Edentulism ( Gradual teeth loss)
--Osteoarthritis and Osteoporosis
--Inability to chew and poor oral health
tmc 28
29. Anesthetsia Implication
• Consider difficult IPPR and Intubation
• Body temperature to be cared during anesthesia
period. Avoid excessive cold temperature in OT
and preferably cover geriatric patient fully.
• Avoid pressure ulcers and padding of pressure
points
• Handle all geriatric patients carefully to avoid
fractures and excessive manipulation during
different surgical position (Handle With Care)
• Pre operative transfer of geriatric patient from
ward to OT is always in presence of medical
attendant (in wheel chair or in supine position)
tmc 29
31. Nervous system Changes
As the nervous system is the target for virtually
every anesthetic drug, so age related changes in
nervous system have essential implications for
anesthetic management
tmc 31
32. Neurologic Changes
• Weight of brain decrease
• Loss of brain cells
• Blood flow to brain
decrease
• State of confusion
• Interference with
Thinking
Reading
Interpreting
Remembering
• Sense of smell, Vision and
hearing diminish
• Impairment of Cognitive
functions increase with age
advancement
• Problems in physiological
regulation of Hypotension
and temperature
tmc 32
33. Anesthesia implication
• Difficulty in Communication, Cooperation &
Coordination
• Cognitive functions to be noted pre operatively
• Old patients take more time to recover from GA
especially if they were disoriented preoperatively
• Old Patient experience varying degrees of delirium
• Sensitive to centrally acting anticholinergic agents
• The % of delirium is less with regional anesthesia,
provided there is no additional sedation
• Dose requirements for local, general & inhalation
anesthetics are reduced
tmc 33
35. Temperature Regulation Changes
Elderly are prone to hypothermia because of
• Lower body metabolism
• Vasodilatation of skin blood flow
• Decrease thermo genesis capability
leading to
– Shivering
– Increase metabolic demand
– Slow drug metabolism
– Increase risk of myocardial ischemia
tmc 35
36. Anesthesia Implication
• Hypothermia should be avoided
• Shivering will increase oxygen demands
• To prevent heat loss
- Use warm solutions
- Use warm Blankets
- Keep OT temperature warm
tmc 36
38. tmc 38
* Slow to respond.
* Increases risk of getting sick.
* An autoimmune disorder may develop.
* Healing is also slowed in older persons.
* The immune system's ability to detect
and correct cell defects also declines.
* increase in the risk of cancer.
40. Psychological Changes
• Loss of physical strength
and abilities
• Loss of mental abilities
(confusion, dementia)
• Loss of relationships
when companions or
friends die
• Loss of self-esteem
• Loss of body image
• Loss of independence
• Loss of control over life
plans and lifestyle
tmc 40
41. Anesthetic Implications
* Geriatric patients with
psychological changes are
difficult to handle for history
taking & physical examination.
* Anesthesiologist should calm,
cooperative and always take
help of family member in pre
assessment.
tmc 41
45. Pre-operative evaluation
1) Complete History
2) Physical Examination
3) Laboratory Investigations
4) Tailor made Anaesthesia plan according to
surgery
tmc 45
46. tmc 46
BEST PRACTICES FOR COMMUNICATION WITH OLDER ADULTS
1) Anaesthesiologist should make the assessment face-to-face, allowing the
patient to see lip movements when speaking; this is particularly
important if the patient has a hearing problem.
2) Voice tone should be clear, slow and slightly louder than usual.
3) The anaesthesiologist should understand by asking leading questions from the
patient or caregiver or companion.
4) One question should be asked at a time, allowing sufficient time for patient
responses. Even healthy older adults may take a little longer to process a
question and frame a response.
5) Communication should be modified to match the individual’s learning style and
incorporate language the patient uses, avoiding complex medical
terminology, acronyms, and abbreviations.
6) If the patient has cognitive impairment, assessment questions should be
verified with the assistance of the family members or primary caregiver.
47. How to communicate with deaf old patients
50 % geriatric patients are having hearing
problem. It is sometimes difficult to
communicate with them.
So, our medical stethoscope will help us
by reversing the ends.
Patients will communicate very nicely.
Simple but very useful way .
tmc 47
48. Complete medical history
History
• CVS and RS complaints
present and past
• Routine activities
• Mental & Physical status
• Dependency
• Associated Diseases
• Drug history/Polypharmacy
• BMI / Nutrition
• Past history Op/Ane. experience
• Any alternative medicine
• Allergy
• Social and Family history
• Any habits
Tobacco/smoking/drinks
• Sleep patterns
Always see for
depression
malnutrition
immobility
dehydration
Denture
Pace maker
Any joint replacement
Any anti depressant Rx
tmc 48
49. So again to repeat, in Assessment
• See whether geriatric patient is able to
perform mental, social and physical activities
• All patients must be examined in presence of
family or friends or guardian
• Always see for polypharmacy because these
group are suffering from 2 or 3 systemic dis.
• Note the cognitive functions status,
to compare pre and post op changes
tmc 49
50. Different Risk factor Scales are available
for
Pre-Assessment
APCHE (Acute Physiological and Chronic
Health Evaluation) for critically ill patients
POSSUM (Physiological and Operative
Severity Score for enumeration of
Mortality and Morbidity) for surgical pts.
Goldman scales of Cardiac risk for non-
cardiac surgery
tmc 50
51. General Physical Examination
• Physical examination of old patient always to
be done in warm area
• General appearance
• Head to Toe Examination for pressure points,
Joints, hearing and vision impairment
• Height / Weight
• Neck mobility, any spine deformity, teeth loss
tmc 51
52. Physical Examination
EXAMINE FOR
• Vital signs
• CVS and RS system
• Oxygen Saturation
• Pain Threshold
• Breathing pattern
• Breath Holding Time
• Clock Drawing Test
• Trail Making test
SEE FOR
• Difficult Intubation
• Difficult regional anae.
• Difficult nerve blocks
• Difficult IV line
• Weight for BMI
• Drugs regularity
• Relatives’ attitude and
responsibility
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53. Investigations
Routine
Complete Haemogram
FBS/HbA1C
ECG
X-Ray Chest
Renal functions
LFTs with proteins
(all above investigations are
must for routine
anesthesia
administration)
Special
According to Positive
medical history & disease
Echocardiography for CVS
Spirometry for RS
Sonography for GIT & KUB
Other Tests according to
Systems affected
e.g. CVS/RS/GIT/URINARY
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54. So, after assessment of geriatric patient
• It is very important to determine the patient’s
status and physiologic reserve in the pre-
anesthetic evaluation.
• The risk from anesthesia is more related with
the presence of co-existing disease than with
the age of the patient.
• The condition should be optimized before
surgery with good nutrition, pharmacological
support, System wise and done without
delay, as long delays increase morbidity rates.
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55. Use of Smartphone in
assessment of geriatric patients
Android apps
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63. In Geriatric Patients
• The circulating level of albumin decreases.
(binding protein for acidic drugs)
• While the level of α-1 acid glycoprotein
increases. (binding protein for basic drugs)
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64. And
• The decrease in total body water
leads to a reduction in the central
compartment and increased serum
concentrations after a bolus administration of
a drug.
• Increase in body fat
results in a greater volume of distribution of
drugs and prolonging action.
• Aging effect on hepatic and renal functions
drug metabolism will be altered
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65. So for,
Dose and Duration of Drugs
One has to remember that
Altered body composition in old age leads
-- decrease blood volume
-- decrease muscle mass
-- decrease plasma proteins
-- decrease circulatory time
-- decrease metabolism & clearance
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66. Doses of Anesthetic Agents
• Sedations – Decrease
• Induction Agents – Decrease (almost 50 % )
• Opioids – Decrease ( Remifentanyl is most potent)
• Muscle Relaxants – No change
• Inhalation Agents – Reduce MAC ( Ideal is 1.5 MAC )
• Local Anesthetics – Decrease
Note :
Ideal inhalation agent for old age is Desflurane
Ideal muscle relaxants for old age is Atracurium
Induction Agents are used according to pre-
assessment and risk of surgery
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67. Regional & Peripheral Nerve Blocks
• The duration of analgesia may be prolonged
with age advancing on the baricity, dose and
strength of the local anesthetic solution
• When GA carries great risk for the patient,
Regional Anesthesia or Nerve Blocks provide
an excellent solution
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68. To Sum-Up Pharmacology of Anaesthesia drugs
• The elderly are more sensitive to anesthetic
agents and generally require smaller doses for
the same clinical effect, and drug action is
usually prolonged.
• One arm brain circulation is about 20 seconds
and drugs to reach their maximum effect
requires 3 to 4 circulation. And in old age this
time is up to 90 seconds. So drug dose
requirement is less.
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69. Drug Strategy for the Elderly:
GO LOW !
GO SLOW !
ALWAYS FOLLOW !
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70. Some words for Fluid administration
--Elderly patient compensates poorly for
hypovolemia & over transfusion.
--After one liter of infusion, better replace blood
loss with blood transfusion
--Liberal oral intake of fluids allowed 2 to 3 hours
preoperatively
--Always keep in mind about elderly
compromised heart, poor organ perfusion and
reduction in GFR for IV fluid administration
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73. Elderly patients are vulnerable and particularly
sensitive to the stress of Trauma, Hospitalization,
Surgery and Anesthesia.
Anesthesiologists must Remember and Do
* Understanding old age physiology and pre operative
management of coexisting disorders
* Meticulous preoperative assessment of organ function
and reserve
* Careful drug selection & dosage titration,
* Careful fluid therapy
* Selection between RA & GA
* Proper psychological preparation & Management
* Good post operative pain control
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