Abstract
elderly patient and non cardiac surgery: What should we know? The surgical procedures in elderly patients are and will be more common. They are characterized by greater morbidity and mortality than those in younger patients, so it is essential an appropriate preoperative evaluation, a diligent intraoperative monitoring and a proper management of the postoperative period. The old age has a number of physiological changes and an increased incidence of chronic diseases and together determine a decline in physiological reserve and functional capacity. In the preoperative evaluation is important a systematic assessment of comorbidities and drugs routinely prescribed, “fragility” of these patients due to the surgical procedure and the risk of developing postoperative cognitive deficit. Type of surgery, degree of urgency and patient conditions are the main factors to consider at time to choose type of anesthesia. Common complications include the development of postoperative delirium and postoperative cognitive decline, where efforts should be directed at prevention rather than treatment, because it significantly increases perioperative morbidity.
Highlights
The surgical procedures in elderly patients are and will be more common. They are characterized by greater morbidity and mortality than those in younger patients, so it is essential an appropriate preoperative evaluation, a diligent intraoperative monitoring and a proper management of the postoperative period
Degree of urgency and patient conditions are the main factors to consider at time to choose type of anesthesia
Common complications include the development of postoperative delirium and postoperative cognitive decline, where efforts should be directed at prevention rather than treatment, because it significantly increases perioperative morbidity
Summary
En la gran mayoría de los adultos mayores existe una disminución de la reserva fisiológica para responder a situaciones de estrés, como una intervención quirúrgica, siendo los sistemas cardiovascular y respiratorio los más afectados por el envejecimiento. Existe una significativa menor termorregulación, con el consiguiente mayor riesgo de hipotermia perioperatoria, la que puede provocar eventos adversos como: complicaciones cardiovasculares (isquemia miocárdica, arritmias, crisis hipertensivas), alteraciones de la coagulación, mayor riesgo de infección de herida operatoria, despertar prolongado postanestésico, disconfort termal (calofríos), etc., los cuales aumentan significativamente la morbimortalidad perioperatoria y la estadía hospitalaria[9]. Las drogas liposolubles tienen mayor volumen de distribución por el aumento de la grasa corporal, retardando su eliminación, como el caso de los fármacos benzodiacepínicos, los cuales aumentan su vida media de eliminación en adultos mayores. La disminución del volumen cerebral total con el envejecimiento está asociada a mayor frecuencia de alteraciones cognitivas y demencia, los cuales son factores predictores de delirium postoperatorio. La Tabla 1 muestra un resumen con los cambios fisiológicos fundamentales en los adultos mayores[6,11]
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