Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg, Hamburg, Germany -
Minerva Anestesiol. 2021 Oct;87(10):1128-1138. doi: 10.23736/S0375-9393.21.15388-X. Epub 2021 May 3.
As octogenarians in the operation room are no longer an exemption but the norm, perioperative management needs to be adopted to meet the special requirements of this group of patients. Anesthesia does not need to be re-invented to fit the elderly. However, as elderly patients are among those most affected by adverse postoperative outcomes, the same diligence that is as a matter of course exercised in anesthesiologic care of the youngest patients' needs to be exercised for the eldest as well. Aging is associated with characteristic physiologic changes and an overall reduction in compensation width. However, the individual relevance of these changes varies distinctly. A comprehensive preoperative assessment is therefore essential to identify those at high risk. Maintaining functionality and preventing cognitive decline are central elements of perioperative care for frail elders, often only requiring unspectacular, but effective adjustments to established routine care processes. This review focuses on current recommendations in the perioperative anesthesiologic management of elderly patients with a view towards assisting clinical anesthesiologists in implementing respective structures in their setting and adjusting care pathways to meet the needs of this vulnerable but growing group of patients and improve their postoperative outcome.
随着 80 岁以上老年人在手术室中已不再是例外而是常态，围手术期管理需要采取措施以满足这组患者的特殊需求。不需要重新发明麻醉来适应老年人。然而，由于老年患者是受术后不良后果影响最大的人群之一，因此在为最年轻的患者进行麻醉护理时理所当然的谨慎，也需要为最年长的患者保持。衰老与特征性的生理变化和整体代偿宽度减少有关。然而，这些变化的个体相关性明显不同。因此，全面的术前评估对于确定高危人群至关重要。维持功能和预防认知能力下降是虚弱老年人围手术期护理的核心要素，通常只需要对既定的常规护理流程进行不引人注目的但有效的调整。这篇综述重点关注老年患者围手术期麻醉管理的当前建议，以期帮助临床麻醉师在其环境中实施相应的结构，并调整护理路径以满足这一脆弱但不断增长的患者群体的需求，改善他们的术后结果。
