Cao Xuezhao, White Paul F, Ma Hong
the First Hospital of China Medical University, Shenyang, China.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Drugs Aging. 2017 Sep;34(9):673-689. doi: 10.1007/s40266-017-0485-3.
The ambulatory setting offers potential advantages for elderly patients undergoing elective surgery due to the advancement in both surgical and anesthetic techniques resulting in quicker recovery times, fewer complications, higher patient satisfaction, and reduced costs of care. This review article aims to provide a practical guide to anesthetic management of elderly outpatients. Important considerations in the preoperative evaluation of elderly outpatients with co-existing diseases, as well as the advantages and disadvantages of different anesthetic techniques on a procedural-specific basis, and recommendations regarding the management of common postoperative complications (e.g., pain, postoperative nausea and vomiting [PONV], delirium and cognitive dysfunction, and gastrointestinal dysfunction) are discussed. The role of anesthesiologists as perioperative physicians is important for optimizing surgical outcomes for elderly patients undergoing ambulatory surgery. The implementation of high-quality, evidence-based perioperative care programs for the elderly on an ambulatory basis has assumed increased importance. Optimal management of perioperative pain using opioid-sparing multimodal analgesic techniques and preventing PONV using prophylactic antiemetics are key elements for achieving enhanced recovery after surgery.
由于手术和麻醉技术的进步，门诊手术环境为接受择期手术的老年患者提供了潜在优势，可实现更快的恢复时间、更少的并发症、更高的患者满意度以及降低护理成本。这篇综述文章旨在为老年门诊患者的麻醉管理提供实用指南。讨论了老年合并疾病门诊患者术前评估中的重要考虑因素，以及不同麻醉技术在特定手术基础上的优缺点，以及关于常见术后并发症（如疼痛、术后恶心呕吐[PONV]、谵妄和认知功能障碍以及胃肠功能障碍）管理的建议。麻醉医生作为围手术期医生的角色对于优化接受门诊手术的老年患者的手术结果至关重要。在门诊基础上为老年人实施高质量、循证围手术期护理计划的重要性日益增加。使用阿片类药物节俭的多模式镇痛技术进行围手术期疼痛的最佳管理以及使用预防性止吐药预防PONV是实现术后加速康复的关键要素。
