Origin
The perioperative care of elderly patients differs from that of younger patients for a number of reasons. Some of these can be attributed to the changes that occur in the process of aging, but many are also caused by diseases that accompany seniority. The distinction between so-called normal aging and pathological changes is critical to the care of elderly people. Anesthesia and surgery has become more common as the population survives longer. Preoperative management of the geriatric patients requires knowledges about changes associated with aging physiology and its relation to surgery and anesthesia. Only experienced anesthetists can evaluate patients effectively and plan for their perioperative care to minimize complications. Comprehensive preoperative evaluation of an elderly individual's health status can be a very challenging aspect, especially for the young anesthetist. Sir William Osler's aphorism "Listen to the patient, he'll give you the diagnosis" is as true in the elderly patient as it is in the young. But in the elderly several factors makes taking history more difficult and time-consuming.
Many differences can be seen in geriatric anesthesia. First, the preoperative evaluation of the geriatric patient is typically more complex than that of the younger patient because of the heterogeneity of this patient group and the greater number and complexity of comorbid conditions that usually accumulate with age. Perioperative functional status can be difficult to predict because many elderly patients have reduced preoperative function as a consequence of deconditioning, age-related disease, or cognitive impairment. This makes it difficult to adequately assess the patient’s ability to respond to the specific stresses associated with surgery. A common example is trying to determine cardiopulmonary reserve in a patient very limited by osteoarthritis. Physiologic heterogeneity and decreased functional reserve are also manifested perioperatively. Normal aging results in changes in cardiac, respiratory, and renal physiology, and the response of the elderly patient to surgical stress is often unpredictable. The pharmacokinetics and pharmacodynamics of elderly and younger patients also differ; moreover, the elderly patient’s use of multiple medications may alter homeostatic mechanisms.
Read more about this topic: Geriatric Anesthesia
Famous quotes containing the word origin:
“We have got rid of the fetish of the divine right of kings, and that slavery is of divine origin and authority. But the divine right of property has taken its place. The tendency plainly is towards ... “a government of the rich, by the rich, and for the rich.””
—Rutherford Birchard Hayes (1822–1893)
“The essence of morality is a questioning about morality; and the decisive move of human life is to use ceaselessly all light to look for the origin of the opposition between good and evil.”
—Georges Bataille (1897–1962)
“The real, then, is that which, sooner or later, information and reasoning would finally result in, and which is therefore independent of the vagaries of me and you. Thus, the very origin of the conception of reality shows that this conception essentially involves the notion of a COMMUNITY, without definite limits, and capable of a definite increase of knowledge.”
—Charles Sanders Peirce (1839–1914)