Van Zundert Tom C R V, Gatt Stephen P, van Zundert André A J
Department of Emergency Medicine, Holy Heart Hospital, Mol, Belgium.
Discipline of Anaesthesia, Critical Care and Emergency Medicine, University of New South Wales, Kensington, NSW, Australia and Udayana University, Bali, Indonesia.
Saudi J Anaesth. 2023 Oct-Dec;17(4):566-574. doi: 10.4103/sja.sja_628_23. Epub 2023 Aug 18.
Demand for anesthesia and analgesia for the frail elderly is continuously increasing as the likelihood of encountering very elderly, very vulnerable, and very compromised patients has, ever so subtly, increased over the last three decades. The anesthesiologist has, increasingly, been obliged to offer professional services to frail patients. Fortunately, there has been a dramatic improvement in medications, methods of drug delivery, critical monitoring, and anesthesia techniques. Specific methodologies peculiar to the frail are now taught and practiced across all anesthesia subspecialties. However, administering anesthesia for the frail elderly is vastly different to giving an anesthetic to the older patient. Frail patients are increasingly cared for in specialized units-geriatric intensive therapy units, post-acute care services, palliative, hospices, and supportive care and aged care facilities. Several medications (e.g., morphine-sparing analgesics) more suited to the frail have become universally available in most centers worldwide so that best-practice, evidence-based anesthesia combinations of drugs and techniques are now increasingly employed. Every anesthetic and pain management techniques in the frail elderly patient are going to be discussed in this review.
在过去三十年中，遇到高龄、极度脆弱且健康状况严重受损患者的可能性已悄然增加，因此对老年体弱患者的麻醉和镇痛需求也在持续上升。麻醉医生越来越有义务为体弱患者提供专业服务。幸运的是，药物、给药方法、重症监测及麻醉技术都有了显著改进。目前，所有麻醉亚专业都在教授和实践针对体弱患者的特定方法。然而，为老年体弱患者实施麻醉与为老年患者进行麻醉有很大不同。体弱患者越来越多地在专门科室接受护理，如老年重症监护病房、急性后期护理服务机构、姑息治疗机构、临终关怀机构以及支持性护理和老年护理机构。在全球大多数中心，几种更适合体弱患者的药物（如吗啡节省型镇痛药）已普遍可用，因此现在越来越多地采用基于证据的最佳麻醉药物和技术组合。本文将探讨老年体弱患者的各种麻醉和疼痛管理技术。
