Department of Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Curr Opin Anaesthesiol. 2009 Dec;22(6):712-7. doi: 10.1097/ACO.0b013e328331a4eb.
Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery.
Demented patients often receive prescribed medication that can interact with various anaesthetic drugs and cause serious side effects. The anaesthesiologist should consider this when choosing the drugs used during surgery and when relieving postoperative pain. Generally, hypnotics, opioids, and inhalational anaesthetics should be administered in lower doses and carefully titrated because of altered pharmacokinetics and pharmacodynamics leading to a great variability, as documented in elderly patients. Neuromuscular blocking agents, and especially rocuronium, display an increased variability in the duration of action, but the new drug sugammadex may reverse the neuromuscular block in a few minutes. Postoperative cognitive decline is more frequent in elderly patients with preexisting cognitive impairment and several preventive measurements can be provided.
Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications.
痴呆在老年患者中很常见，麻醉医生在管理这些特别脆弱的患者时面临越来越多的挑战。本文旨在强调与痴呆患者相关的一些最重要的围手术期问题，包括麻醉相关问题和其他方面，以确保患者快速、平稳地康复。
痴呆患者经常服用规定的药物，这些药物可能与各种麻醉药物相互作用，导致严重的副作用。麻醉医生在选择手术期间使用的药物和缓解术后疼痛时应考虑到这一点。一般来说，由于改变了药代动力学和药效动力学，导致老年人存在较大的变异性，因此应降低催眠药、阿片类药物和吸入性麻醉剂的剂量，并小心滴定。神经肌肉阻滞剂，特别是罗库溴铵，其作用持续时间的变异性增加，但新的药物琥珀胆碱可能会在几分钟内逆转神经肌肉阻滞。术前认知功能障碍的老年患者术后认知功能下降更为常见，可以采取多种预防措施。
痴呆患者的门诊手术在麻醉方面存在许多问题。可能会出现广泛的药物相关问题，建议限制药物使用以避免严重并发症。
