Department of Anaesthesia, Leeds Teaching Hospital Trust, The General Infirmary at Leeds, Leeds, UK.
Drugs Aging. 2010 Apr 1;27(4):265-82. doi: 10.2165/11534990-000000000-00000.
Our population is aging; currently 15% of the Western population are aged >65 years, and represent 25% of those undergoing surgery. The proportion of the population aged >or=65 years is rapidly growing, and an increasing number are affected with cardiovascular disease. The older person is a high-risk patient. This is because of their altered physiology and associated co-morbidities, as well as the pharmacokinetic and pharmacodynamic changes that may alter drug responses. There is considerable variability seen in the physical and physiological states of individual patients within the older population. This has an important impact on choosing a safe anaesthetic technique for each individual, which in turn can influence the morbidity and mortality in this population. The physiological changes in the aging cardiovascular system affect the arterial and venous vasculature, myocardium and autonomic nervous system, making the older person more prone to cardiovascular instability. In addition to the physiological changes, the cardiovascular status of the older person tends to be compromised by associated pathological conditions that are more common with increasing age. Pharmacokinetic and pharmacodynamic changes must be taken into account when deciding about drug dosing in this age group. Aspects of dose reduction, titration of drugs, dosing intervals and the pharmacodynamic effects of each class of drug are explained in detail in the text. The major challenge in anaesthesia for the older person with cardiovascular disease is maintenance of haemodynamic stability, particularly in the face of reduced physiological reserve and capability to respond to periods of instability. An appropriate anaesthetic technique must be selected to minimize haemodynamic changes and maintain near normal physiological status. The other key objective is to minimize the incidence of adverse outcomes, such as perioperative myocardial ischaemia/infarction, arrhythmias, heart failure, postoperative cognitive dysfunction and stroke. No single anaesthetic regimen or agent can be advocated. Knowledge of the pharmacokinetic and pharmacodynamic principles of anaesthetic agents and their altered response in elderly patients is essential when selecting an anaesthetic agent. This article provides a practical guide to the selection and use of general anaesthetic agents in older patients with cardiovascular disorders, highlighting the differences among various agents.
我们的人口正在老龄化；目前，西方人口中有 15%的年龄在 >65 岁，其中 25%的人正在接受手术。年龄 >or=65 岁的人口比例正在迅速增长，越来越多的人患有心血管疾病。老年人是高风险患者。这是由于他们的生理改变和相关的合并症，以及可能改变药物反应的药代动力学和药效学变化。在老年人群中，个体患者的身体和生理状态存在相当大的差异。这对为每个个体选择安全的麻醉技术有重要影响，进而影响该人群的发病率和死亡率。衰老心血管系统的生理变化影响动脉和静脉血管、心肌和自主神经系统，使老年人更容易出现心血管不稳定。除了生理变化外，老年人的心血管状况往往因与年龄增长相关的病理状况而受到影响。在决定该年龄段的药物剂量时，必须考虑药代动力学和药效学变化。在文本中详细解释了剂量减少、药物滴定、给药间隔以及每类药物的药效学作用等方面的内容。在有心血管疾病的老年人的麻醉中，主要挑战是维持血流动力学稳定，特别是在生理储备减少和应对不稳定期的能力降低的情况下。必须选择适当的麻醉技术，以最大限度地减少血流动力学变化并维持接近正常的生理状态。另一个关键目标是最大限度地减少不良后果的发生率，如围手术期心肌缺血/梗死、心律失常、心力衰竭、术后认知功能障碍和中风。没有单一的麻醉方案或药物可以被推荐。了解麻醉药物的药代动力学和药效学原则及其在老年患者中的改变反应对于选择麻醉药物至关重要。本文为老年心血管疾病患者选择和使用全身麻醉药物提供了实用指南，突出了各种药物之间的差异。
