Chapter

Pre-operative assessment and preparation of elderly patients undergoing major surgery

Chris Dodds, Chandra M. Kumar and Frédérique Servin

in Anaesthesia for the Elderly Patient

Published on behalf of Oxford University Press

Published in print October 2007 | ISBN: 9780199234622
Published online May 2011 | e-ISBN: 9780199607082 | DOI: http://dx.doi.org/10.1093/med/9780199234622.003.0004

Series: Oxford Anaesthesia Library

Pre-operative assessment and preparation of elderly patients undergoing major surgery

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Age as such is not a good predictor of surgical risk.

Physiological age-related changes increase the risks of surgery and anaesthesia.

Co-morbidities increase with age.

Anaesthetic plan for surgery in elderly is a challenge.

Aim of assessment is to identify within the composite elderly patient what integrated responses are critically reduced, or have failed, and then to systematically review individual organ systems for functional reserve.

Incidence of ischaemic heart disease and valve disease increases with age and is associated with increased morbidity and mortality.

Chest disease is common in the elderly, and pulmonary complications are more common in the post-operative period.

Hepatic insufficiency usually results in a poor surgical outcome.

Renal insufficiency associated with uraemia increases risk.

Presence of interval delirium or confusion indicates a very high risk of post-operative cognitive impairment and general anaesthetic or sedation should be avoided.

Before emergency surgery, there may not be time for complete evaluation and correction of risk factors.

Life saving treatment can proceed without consent.

Advance directives before surgery should be documented, and the name of the patient’s surrogate should be recorded.

Chapter.  3594 words. 

Subjects: Anaesthetics

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