Strøm Camilla, Rasmussen Lars Simon, Steinmetz Jacob
Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Drugs Aging. 2016 Nov;33(11):765-777. doi: 10.1007/s40266-016-0413-y.
The elderly population is rapidly growing and particularly diverse. Ageing leads to reduced organ function and a decline in physiologic reserve. Elderly patients are characterised by great inter-individual variability in physiological function with a high prevalence of chronic disease. In general, older patients have a higher risk of postoperative adverse outcomes, and frailty is a very important risk factor. This review article aims to provide a practical guide to anaesthetic management of the elderly surgical patient. To optimise care, clinicians should be familiar with the typical physiologic changes related to ageing and the implications for anaesthetic management. All anaesthetic techniques, methods and agents can be applied, if tailored to the patient's physiologic and pathologic changes. The elderly are more sensitive to anaesthetics, meaning that desired sedative and analgesic effects are reached at lower doses compared with younger patients, and the haemodynamic depressing side effects of anaesthetics are often more pronounced. To reduce the risk of circulatory collapse, the clinician should carefully titrate anaesthetics and await the response with patience. The dose of neuromuscular blocking agents should rarely be reduced for intubation, but the duration of action of neuromuscular blocking agents is often prolonged and difficult to predict. Perioperative neuromuscular monitoring is therefore strongly recommended. In the postoperative period, prevention of avoidable morbidity and functional decline is crucial; comprehensive multidisciplinary care and multimodal interventions may facilitate earlier recovery and decrease the risk of complications.
老年人口正在迅速增长且具有显著的多样性。衰老会导致器官功能减退和生理储备下降。老年患者的生理功能个体差异很大，且慢性病患病率很高。一般来说，老年患者术后出现不良后果的风险更高，而虚弱是一个非常重要的风险因素。这篇综述文章旨在为老年外科患者的麻醉管理提供实用指南。为了优化护理，临床医生应熟悉与衰老相关的典型生理变化及其对麻醉管理的影响。如果根据患者的生理和病理变化进行调整，所有麻醉技术、方法和药物都可以应用。老年人对麻醉药更为敏感，这意味着与年轻患者相比，较低剂量就能达到所需的镇静和镇痛效果，而且麻醉药的血流动力学抑制副作用往往更明显。为降低循环衰竭的风险，临床医生应仔细调整麻醉药剂量并耐心等待反应。用于插管时，神经肌肉阻滞剂的剂量很少需要减少，但神经肌肉阻滞剂的作用时间往往会延长且难以预测。因此，强烈建议进行围手术期神经肌肉监测。在术后阶段，预防可避免的发病和功能衰退至关重要；全面的多学科护理和多模式干预可能有助于更早康复并降低并发症风险。
