Department of Anesthesiology, State University of New York, Downstate Health Sciences Center, Brooklyn, NY.
J Neurosurg Anesthesiol. 2020 Jan;32(1):9-17. doi: 10.1097/ANA.0000000000000640.
Better ways to manage preoperative, intraoperative and postoperative care of surgical patients is the bailiwick of anesthesiologists. Although we care for patients of all ages, protecting the cognitive capacity of elderly patients more frequently requires procedures and practices that go beyond routine care for nonelderly adults. This narrative review will consider current understanding of the reasons that elderly patients need enhanced care, and recommendations for that care based on established and recent empirical research. In that latter regard, unless and until we are able to classify anesthetic neurotoxicity as a rare complication, the first-do-no-harm approach should: (1) add anesthesia to surgical intervention on the physiological cost side of the cost/benefit ratio when making decisions about whether and when to proceed with surgery; (2) minimize anesthetic depth and periods of electroencephalographic suppression; (3) limit the duration of continuous anesthesia whenever possible; (4) consider the possibility that regional anesthesia with deep sedation may be as neurotoxic as general anesthesia; and (5) when feasible, use regional anesthesia with light or no sedation.
更好地管理手术患者的术前、术中和术后护理是麻醉师的职责范围。尽管我们照顾所有年龄段的患者，但保护老年患者的认知能力通常需要采取超出非老年成年人常规护理的程序和做法。本叙述性综述将考虑目前对老年患者需要加强护理的原因的理解，以及基于既定和最新实证研究的护理建议。在后一方面，除非我们能够将麻醉神经毒性归类为罕见并发症，否则在决定是否以及何时进行手术时，首先不造成伤害的方法应该是：（1）在考虑是否进行手术时，将麻醉添加到手术干预的生理成本方面，以平衡成本/收益比；（2）尽量减少麻醉深度和脑电图抑制的时间；（3）尽可能限制连续麻醉的持续时间；（4）考虑深度镇静的区域麻醉可能与全身麻醉一样具有神经毒性；（5）在可行的情况下，使用轻度镇静或无镇静的区域麻醉。
