Sharma Ram M, Garg Anurag, Parikh Badal
Department of Anesthesiology, Critical Care and Pain Management, Army Hospital (R&R), New Delhi, India.
Saudi J Anaesth. 2020 Oct-Dec;14(4):531-534. doi: 10.4103/sja.SJA_85_20. Epub 2020 Sep 24.
With the rise in living standards and evolution of science, there is a rise in life expectancy world over. This demographic transition has led to a rise in older persons, increasing the dependency ratios and "demographic burden." Management of such old patients requires special considerations and understanding as aging is a physiological phenomenon in which the functional capacity of organs decreases due to degenerative changes in the structure. An important aspect to remember in Geriatric Anesthesia is that in spite of adequate compensatory mechanisms for age-related changes, there is a limitation of physiological reserve, especially in stressful circumstances like perioperative period. Geriatric patients are more sensitive to all medications and anesthetic agents. Lesser amount of drug is required to achieve the desired clinical effect, but have a prolonged effect. This elderly but well-preserved patient, possibly a case of small gut obstruction was posted for emergency laparoscopy and proceed. Seeing his age and easy friability, a well-planned preoperative assessment and optimization was done prior to wheeling him into operation theater. Administration of short-acting anesthetic drugs in titrated quantities and awareness about postoperative cognitive dysfunction (POCD) helped us to get better and faster recovery in the patient.
随着生活水平的提高和科学的发展，全世界的预期寿命都在增加。这种人口结构转变导致老年人数量增加，抚养比上升，“人口负担”加重。管理这类老年患者需要特殊的考虑和理解，因为衰老是一种生理现象，由于结构的退行性变化，器官的功能能力会下降。老年麻醉中需要记住的一个重要方面是，尽管存在针对与年龄相关变化的充分代偿机制，但生理储备仍有限，尤其是在围手术期等应激情况下。老年患者对所有药物和麻醉剂更为敏感。达到预期临床效果所需的药物量较少，但作用时间延长。这位年事已高但身体状况尚好的患者，可能是小肠梗阻病例，被安排进行急诊腹腔镜检查并继续手术。考虑到他的年龄和易脆的身体状况，在将他推进手术室之前进行了精心规划的术前评估和优化。给予小剂量的短效麻醉药物，并关注术后认知功能障碍（POCD），这有助于患者更好更快地康复。
