Anaesthesia and the elderly patient, seeking better neurological outcomes

  • Cristina Alexandra Benavides-Caro Anaesthetist Physician, Specialist in Bioethics, Adjunct Associate Professor in Neuroanaesthesia, Fundación Universitaria Sanitas, Bogotá, Colombia
Keywords: Aged, Anesthesia, Postoperative complications, Anesthesia conduction, General surgery.

Abstract

Introduction: Elderly patients in need of surgery under anaesthesia present the challenge of maintaining their especially delicate balance under stress conditions.

Objective: This review of the literature aims to bring the anaesthesiologist closer to this group of patients, examining some of the physiological changes that occur with ageing, the effects that anaesthesia might have on their postoperative neurological state, the monitoring options, and the most frequent neurological complications.

Materials and methods: A search was conducted in the LILACS, MEDLINE and GOOGLE SCHOLAR databases using the terms anaesthesia, elderly, outcomes and neurologic, together with an ambispective snowball search from 2000 until today.

Conclusion: Institutions and staff responsible for the care of elderly patients must have the training and knowledge necessary for providing comprehensive treatment to this group of patients, in order to help them maintain their independence and physical and mental health which are so important during the final stage of life.

References

1. United Nations, Department of Economic and Social Affairs, Population Division, United Nations, New York 2010. World population ageing. New York: Population Division, United Nations; 2010.
2. Lopez JH, Lopez R. Sobre la muerte: a quien pueda interesar. Rev Colomb Anestesiol. 2012;40:195-8.
3. Ward SA, Parikh S, Workman B. Health perspectives: international epidemiology of ageing. Best Pract Res Clin Anaesthesiol. 2011;25:305-17.
4. Fuchs J, Scheidt-Nave C, Hinrichs T, Mergenthaler A, Stein J, Riedel-Heller SG, et al. Indicators for healthy ageing - a debate. Int J Environ Res Public Health. 2013;10:6630-14.
5. Zhuravleva T, Alperin B, Haring A, Rentz D. Age-related decline in bottom-up and selective attention in the very old. J Clin Neurophysiol. 2014:261-71.
6. Peden CJ, Grocott MPW. National research strategies: what outcomes are important in peri-operative elderly care? Anaesthesia. 2014;69:61-9.
7. Yang R, Wolfson M, Lewis MC. Unique aspects of the elderly surgical population: an anesthesiologist's perspective. Geriatr Orthop Surg Rehabil. 2011:56-64.
8. Silbert B, Evered L, Scott DA. Cognitive decline in the elderly: is anaesthesia implicated? Best Pract Res Clin Anaesthesiol. 2011;25:379-93.
9. Glance LG, Osler TM, Neuman MD. Redesigning surgical decision making for high-risk patients. N Engl J Med. 2014;370:1379-81.
10. Deiner S, Jeffrey H. Long-term outcomes in elderly surgical patients. Mt Sinai J Med Med. 2013;79:95-106.
11. Guenther U, Radtke FM. Delirium in the postanaesthesia period. Curr Opin Anaesthesiol. 2011;24:670-5.
12. McDaniel M, Brudney C. Postoperative delirium: etiology and management. Curr Opin Crit Care. 2012;18:372-6.
13. Alcover L, Badenes R, Montero MJ, Soro M, Belda FJ. Postoperative delirium and cognitive dysfunction. Trends Anaesth Crit Care. 2013;3:199-204.
14. Monk TG, Price CC. Postoperative cognitive disorders. Curr Opin Crit Care. 2011;17:376-81.
15. Grape S, Ravussin P, Rossi A, Kern C, Steiner LA. Postoperative cognitive dysfunction. Trends Anaesth Crit Care. 2012;2:98-103.
16. Moller J, Cluitmans P, Rasmussen L, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study. Lancet. 1998;351:857-61.
17. Monk TG, Weldon BC, Garvan CW, Dede DE, Van der Aa MT, Heilman KM, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008;108:18-30.
18. Long L, Shapiro W, Leung J. A brief review of practical preoperative cognitive screening tools. Can J Anaesth. 2012;59:798-804.
19. Gurlit S, Mollmann M. How to prevent perioperative delirium in the elderly? Z Gerontol Geriatr. 2008;41:447-52.
20. Kim S, Brooks AK. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes. Clin Interv Aging. 2015;10:13-27.
21. Brown EN, Purdon PL. The aging brain and anesthesia. Curr Opin Anaesthesiol. 2013;26:414-9.
22. Fontana L. Modulating human aging and age-associated diseases. Biochim Biophys Acta. 2009;1790:1133-8.
23. Yau PL, Hempel R, Tirsi A, Convit A. Cerebral white matter and retinal arterial health in hypertension and type 2 diabetes mellitus. Int J Hypertens. 2013:3296-302.
24. Stone P, Doherty P. Anaesthesia for elderly patients. Anaesth Intensive Care Med. 2007;8:361-4.
25. Miyawaki CE. Association of social isolation and health across different racial and ethnic groups of older Americans. Ageing Soc. 2015;35:2201-28.
26. Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol. 2014;63:747-62.
27. Str0m C, Rasmussen LS, Sieber FE. Should general anaesthesia be avoided in the elderly? Anaesthesia. 2014;69:35-44.
28. Marcantonio ER, Rudolph JL, Culley D, Crosby G, Alsop D, Inouye SK. Serum biomarkers for delirium. J Gerontol A Biol Sci Med Sci. 2006;61:1281-6.
29. van den Boogaard M, Kox M, Quinn KL, van Achterberg T, van der Hoeven JG, Schoonhoven L, et al. Biomarkers associated with delirium in critically ill patients and their relation with long-term subjective cognitive dysfunction; indications for different pathways governing delirium in inflamed and noninflamed patients. Crit Care. 2012;15:1-9.
30. Leung JM, Tsai TL, Sands LP. Preoperative frailty in older surgical patients is associated with early postoperative delirium. Anesth Analg. 2011;112:1199-201.
31. Hubbard RE, Story DA. Patient frailty: the elephant in the operating room. Anaesthesia. 2014;69:26-34.
32. Partridge JSL, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing. 2012;41:142-7.
33. Curcio C-L, Henao G-M, Gomez F. Frailty among rural elderly adults. BMC Geriatr. 2014;10:2.
34. McMillan GJ, Hubbard RE. Frailty in older inpatients: what physicians need to know. QJM. 2012;105:1059-65.
35. Jevtovic-Todorovic V, Absalom AR, Blomgren K, Brambrink A, Crosby G, Culley DJ, et al. Anaesthetic neurotoxicity and neuroplasticity: an expert group report and statement based on the BJA Salzburg Seminar. Br J Anaesth. 2013;111:143-51.
36. Lin EP, Soriano SG, Loepke AW. Anesthetic neurotoxicity. Anesthesiol Clin. 2014;32:133-55.
37. Callaway JK, Jones NC, Royse AG, Royse CF. Memory impairment in rats after desflurane anesthesia is age and dose dependent. J Alzheimer's Dis. 2015;44:995-1005.
38. Whittington RA, Bretteville A, Dickler MF, Planel E. Anesthesia and tau pathology. Prog Neuropsychopharmacol Biol Psychiatry. 2013;47:147-55.
39. Slor CJ, De Jonghe JF, Vreeswijk R, Groot E, Ploeg TV, Van Gool WA, et al. Anesthesia and postoperative delirium in older adults undergoing hip surgery. J Am Geriatr Soc. 2011;59:1313-9.
40. Le-Wendling L, Bihorac A, Baslanti TO, Lucas S, Sadasivan K, Wendling A, et al. Regional anesthesia as compared to general anesthesia for surgery in geriatric patients with hip fracture: does it decrease morbidity, mortality and healthcare costs? Results of a single centered study. Pain Med. 2012;13:948-56.
41. Bryson GL, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth. 2006;53:669-77.
42. White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia. 2014;69:224-30.
43 Halaszynski TM. Pain management in the elderly and cognitively impaired patient: the role of regional anesthesia and analgesia. Curr Opin Anaesthesiol. 2009;22:594-9.
44. Inés M, Valencia B. Envejecimiento de la población: un reto para la salud pública. Rev Colomb Anestesiol. 2012;40:192-4.
45. Veering B. Regional anaesthesia in the elderly. Eur Soc Anaesthesiol. 2011:18-21.
46. Ellerkmann RK, Soehle M, Kreuer S. Brain monitoring revisited: what is it all about? Best Pract Res Clin Anaesthesiol. 2013;27:225-33.
47. Sessler DI, Sigl JC, Kelley SD, Chamoun NG, Manberg PJ, Saager L, et al. Hospital stay and mortality are increased in patients having a "triple low" of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia. Anesthesiology. 2012;116:1195-203.
48. Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100:4-10.
49. Leslie K, Short TG. Low bispectral index values and death: the unresolved causality dilemma. Anesth Analg. 2011;113:660-3.
50. Leslie K, Myles PS, Forbes A, Chan MTV. The effect of bispectral index monitoring on long-term survival in the B-aware trial. Anesth Analg. 2010;110:816-22.
51. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103:i3-13.
52. Grocott HP. Avoid hypotension and hypoxia: an old anesthetic adage with renewed relevance from cerebral oximetry monitoring. Can J Anaesth. 2011;58:697-702.
53. Hoppenstein D, Zohar E, Ramaty E, Shabat S, Fredman B. The effects of general vs spinal anesthesia on frontal cerebral oxygen saturation in geriatric patients undergoing emergency surgical fixation of the neck of femur. J Clin Anesth. 2005;17:431-8.
54. Burkhart CS, Rossi A, Dell-Kuster S, Gamberini M, Môckli A, Siegemund M, et al. Effect of age on intraoperative cerebrovascular autoregulation and near-infrared spectroscopy-derived cerebral oxygenation. Br J Anaesth. 2011;107:742-8.
55. Papadopoulos G, Karanikolas M, Liarmakopoulou A, Papathanakos G, Korre M, Beris A. Cerebral oximetry and cognitive dysfunction in elderly patients undergoing surgery for hip fractures: a prospective observational study. Open Orthop J. 2012;6:400-5.
56. Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S, et al. Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. Eur J Anaesthesiol. 2007;24:59-65.
57. Meng L, Gelb W. Oximetria cerebral: tres preguntas esenciales. Rev Colomb Anestesiol. 2015;3:52-6.
How to Cite
1.
Benavides-Caro CA. Anaesthesia and the elderly patient, seeking better neurological outcomes. Colomb. J. Anesthesiol. [Internet]. 2016Apr.1 [cited 2021May12];44(2):128–133. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/465

Downloads

Download data is not yet available.
Published
2016-04-01
How to Cite
1.
Benavides-Caro CA. Anaesthesia and the elderly patient, seeking better neurological outcomes. Colomb. J. Anesthesiol. [Internet]. 2016Apr.1 [cited 2021May12];44(2):128–133. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/465
Section
Narrative review