Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Br J Anaesth. 2019 Jul;123(1):37-50. doi: 10.1016/j.bja.2019.03.034. Epub 2019 May 3.
Frailty is a syndrome of cumulative decline across multiple physiological systems, which predisposes vulnerable adults to adverse events. Assessing vulnerable patients can potentially lead to interventions that improve surgical outcomes. Anaesthesiologists who care for older patients can identify frailty to improve preoperative risk stratification and subsequent perioperative planning. Numerous clinical tools to diagnose frailty exist, but none has emerged as the standard tool to be used in clinical practice. Radiological modalities, such as computed tomography and ultrasonography, are widely performed before surgery, and are therefore available to be used opportunistically to objectively evaluate surrogate markers of frailty. This review presents the importance of frailty assessment by anaesthesiologists; lists common clinical tools that have been applied; and proposes that utilising radiological imaging as an objective surrogate measure of frailty is a novel, expanding approach for which anaesthesiologists can significantly contribute to broad implementation.
衰弱是一种多生理系统累积衰退的综合征，使脆弱的成年人易发生不良事件。评估脆弱患者可能会导致改善手术结果的干预措施。照顾老年患者的麻醉师可以识别衰弱，以改善术前风险分层和随后的围手术期计划。目前存在许多用于诊断衰弱的临床工具，但没有一种工具成为临床实践中使用的标准工具。放射影像学方法，如计算机断层扫描和超声检查，在手术前广泛进行，因此可以利用这些影像学方法来客观地评估衰弱的替代标志物。本综述介绍了麻醉师进行衰弱评估的重要性；列出了已应用的常见临床工具；并提出将放射影像学作为衰弱的客观替代指标是一种新颖的、不断发展的方法，麻醉师可以为其广泛实施做出重大贡献。
