Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Curr Opin Anaesthesiol. 2013 Aug;26(4):414-9. doi: 10.1097/ACO.0b013e328362d183.
To review the neurophysiology and neuroanatomy of normal aging and the recent recommendations for the clinical management of general anesthesia and sedation in the elderly.
As the population ages, the number of elderly patients having surgery is likewise increasing and with it, the prevalence of postoperative cognitive disorders. Postoperative cognitive disorders including delirium and postoperative cognitive dysfunction are common postanesthesia complications in elderly patients. Several risk factors for postoperative disorders have been identified, and anesthesiologists commonly adapt their practice habits when taking care of elderly patients to try to mitigate the effects of the anesthetics on postoperative cognitive function. These practices are reasonable and prudent; yet, they are not well supported by an understanding of the aging brain and specifics of how the anesthetic effects on the brain change with age. Through functional imaging and electrophysiological studies, much is being learned about the neurophysiology and the neuroanatomy of normal aging.
Our analysis suggests that understanding the neurophysiology and neuroanatomy should be part of the standard working knowledge of anesthesiologists and that this knowledge can guide their use of the electroencephalogram to track more accurately the brain states of elderly patients receiving anesthesia care.
综述正常衰老的神经生理学和神经解剖学，以及老年人全身麻醉和镇静的临床管理的最新建议。
随着人口老龄化，接受手术的老年患者数量也在增加，随之而来的是术后认知障碍的发病率增加。术后认知障碍包括谵妄和术后认知功能障碍，是老年患者全身麻醉后的常见并发症。已经确定了几个术后障碍的危险因素，麻醉师在照顾老年患者时通常会调整他们的实践习惯，以尽量减轻麻醉对术后认知功能的影响。这些做法是合理和谨慎的；然而，它们并没有很好地理解衰老大脑，也没有很好地理解麻醉对大脑的影响如何随年龄而变化。通过功能成像和电生理学研究，我们对正常衰老的神经生理学和神经解剖学有了更多的了解。
我们的分析表明，理解神经生理学和神经解剖学应该成为麻醉师标准工作知识的一部分，并且这方面的知识可以指导他们使用脑电图更准确地跟踪接受麻醉护理的老年患者的大脑状态。
