老年病人的麻醉管理课件

老年病人的麻醉管理
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# Older Americans
> 65 yrs > 80 yrs
2000 2030 12.4% 19.6% 35 mil 71 mil 9.3 mil 19.5 mil
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The Oldest…..
• MAN
120 yrs
• WOMAN
Fleisher. Anesth Analg 1999; 89:849
25%
20%
ห้องสมุดไป่ตู้
15%
10%
5%
0% <65 66-70 71-75 76-80 81-85 >85 yrs
老年病人的麻醉管理
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aortic infrainquinal
Perioperative Complication Rates in Medicare Patients
• Intermediate Risk Surgery - 42%
– Silber, Anesthesiology 2000; 93:152 – 217,440 general & orthopedic surgery
• Low Risk Surgery - 3%
– Schein, N Engl J Med 2000; 342:168 – 18,901 cataract surgery
– Urinalysis if hip surgery or acutely ill – Cook & Rooke, Anesth Analg 2003; 96:1823
• Treatment effectiveness - YES • Baseline – MAYBE, but overused • Risk Assessment - YES
– Age may = disease when > 85 yrs – Increase ASA PS when > 85 yrs
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Preoperative Considerations
• Preoperative Assessment
– No routine preoperative testing – Statin myopathic syndromes – Diastolic dysfunction
– Natural death (no trauma or disease)
• Life Expectancy (USA)
67-80
– Premature death (trauma, disease)
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Oldest Surgical Patient?
Oliver. Br J Anaesth 2000; 84:260
Clergue. Anesthesiology 1999; 91:1509 (France)
Ages (yrs) Men
Women
35 – 44
8.9
55 - 64
17.7
75 - 84
30.2
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13.2 14.6 23.6
Vascular Surgery – Mortality vs Age
– Guinness Book of Records
122
• GENERAL ANESTHETIC 113
– Br J Anaesth 2000; 84:260
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Life Expectancy at birth USA - 1997
WOMEN Caucasian
79.9 yrs
African-American 74.7
• Woman, 113 yrs, femoral fracture • General anesthesia • CVP, no arterial-line • Extubation in ICU after 5h • Hospital discharge POD 23
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# Anesthetics per 100 Population?
Ed老uc年a病tio人n的: A麻n醉n管ua理l Meeting – American Soc1iety of Anesthesiologists
Hayflick’s View of Aging
“Because modern humans, unlike feral
animals, have learned how to escape death long after reproductive success, we have revealed a process that, teleologically, was never intended for us to experience.”
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Age & Perioperative Outcome
• With advancing age
– More surgery – Morbidity increases – Mortality increases
• Cause - disease vs age ?
– Disease > age when < 85 yrs
• Diabetes Mellitus
– Tighter glucose control with insulin – Stop oral hypoglycemic agents
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Why Obtain Preoperative Tests?
• Screening – NO with one exception
MEN Caucasian
74.3
African-American 67.2
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Life Expectancy, Life Span, & Maximum Length of Life
• Maximum Length of Life
> 120 yrs
• Life Span
85-100
Anesthetic Management of the Elderly Patient
Raymond C. Roy, PhD, MD Professor & Chair of Anesthesiology Wake Forest University Health Sciences Winston-Salem, NC, USA 27157-1009