Geriatric AnesthesiaMany patients and their families express concern regarding the safety of administering an anesthetic to the geriatric patient. Elderly patients have a higher postoperative complication rate when compared to younger patients but age alone does not preclude the administration of a safe anesthetic for surgery. Patients of advanced age typically have concomitant diseases and require a more sophisticated approach to their presurgical preparation. Often the Anesthesiologist will request consultations from other physician specialists caring for the patient who can give a complete and detailed picture of the patient’s current state of health. This type of information gathering and preoperative preparation will greatly enhance the ability of the anesthesiologist in crafting the safest anesthetic plan for surgery.
As a routine part of preoperative preparation, a patient’s daily medications are carefully reviewed and clear instructions are given as to which medicines are to be continued on the day of surgery. These are taken with a small sip of water. After review of the preoperative anesthesia questionnaire (typically completed by the patient prior to surgery) the Anesthesiologist will began to outline the safest anesthetic approach for the patient’s surgical procedure.
Elderly patients can be sensitive to our anesthetic drugs. During surgery we carefully monitor the effects of our anesthetics and often administer smaller doses to the geriatric patient. Careful attention to sophisticated monitors helps guide this process.
General anesthesia may be more stressful on the heart and lungs and whenever possible alternative techniques may be suggested. Local anesthesia with sedation, regional anesthesia ( nerve blocks) and spinal anesthesia may be preferable for some types of surgery. These techniques allow for less total anesthetic medication to be administered while providing a pain free operative experience. The patient will often be more alert and ready for discharge at an earlier time when these alternative techniques are utilized. During all operations particular attention is devoted to keeping elderly patients warm in the operating room, padding their extremities, and avoiding tears of fragile skin.
Careful post operative pain management is paramount to a successful anesthetic. Preoperative nerve blocks are utilized whenever possible to provide postoperative pain relief and reduce the need for narcotics which while effective can cause confusion or nausea in the elderly patient. A typical recovery room stay may be longer because many anesthetics are eliminated at a slower rate in the elderly. Patients are monitored in the recovery room and will only be discharged when awake and comfortable.
Northeastern Anesthesia Services has extensive experience with elderly patients. Despite their age our geriatric patients can expect a safe and comfortable experience in our operating rooms.
AwarenessThe media has certainly done its part to get people thinking about intraoperative awareness. From multiple late night news reports, to the movie, "Awake", patients' preoperative anxiety levels have risen noticeably. This issue is without doubt, one of the more common concerns expressed to us by patients before their operations and as such deserves a thorough explanation.