Regional analgesia can often be extremely beneficial for elderly pa¬tients. One advantage of regional techniques is Ihe reduced amount of narcotic needed. The disadvantages include (he hemodynamic changes associated with epidural local anesthetics and the potential for intravas¬cular injection, infection, bleeding, and nerve damage. When a regional anesthetic block is performed before a painful stimulus [...]
Rehabilitation may require only one discipline, but usually it draws on the coordinated efforts of more than one. When a complex problem requires expertise from several disciplines, a rehabilitation team can develop a program to coordinate therapy. Usually, rehabilitation programs are organized around a particular type or set of problems. For example, a program may [...]
Epidural analgesia: After hip. abdominal, or (horacic procedures, a continuous epidural technique is often used for analgesia. An infusion of bupivacaine 0.125% to 0.0625% solution containing fentanyl 4 to 5 usually provides excellent analgesia. When the epidural cathe¬ter is placed at the dermatome level where discomfort is perceived, the amount of local anesthelic and narcotic [...]
Regional analgesia can often be extremely beneficial for elderly pa¬tients. One advantage of regional techniques is Ihe reduced amount of narcotic needed. The disadvantages include (he hemodynamic changes associated with epidural local anesthetics and the potential for intravas¬cular injection, infection, bleeding, and nerve damage. When a regional anesthetic block is performed before a painful stimulus [...]
Narcotic analgesics have been the traditional mainstay of postopera¬tive pain control. However, before ordering a narcotic, the physician should consider its effect and side effects. The same dose given to a young adull and an older adult will have a stronger effect on the older one. In older patients, important clinical side effects are usually [...]
Controlling postoperative pain in Ihe elderly can be difficult. The major goal of such control is paCieni comfort; a secondary goal is de¬creased morbidity and mortality. Adequate analgesia may improve car¬diovascular and pulmonary function. By preventing Ihe stress response to postoperative pain, adequate analgesia may also lower the incidence of postoperative myocardial events. Much of [...]
Other Considerations Obtaining vascular access to use monitoring devices and to adminis¬ter drugs, fluids, and blood can be a challenge in the elderly. Arthritic changes can make inlubalion and positioning for surgery difficult. Also, increased skin fragility makes the elderly person prone to injury from restraining devices, tape, Bovie pads, and adhesive monitoring devices such [...]
General anesthesia provides loss of conscious¬ness, amnesia, analgesia, and a variable degree of muscle relaxation. Generally, the patient’s airway is secured with an endotracheal lube, and ventilation is controlled. Most of the general anesthetics are potent myocardial depressants and vasodilators. The metabolism of these drugs is governed by the pharmacokinetic factors described above. The dosage [...]
Depending on the circumstances, the anesthesiologist may provide monitored anesthesia care, regional anesthesia, or general anesthesia. Monitored anesthesia care: When patients do not need analgesia for a procedure or when the surgeon administers it, the anesthesiologist pro¬vides monitored anesthesia care, which consists of monitoring the pa-tient”s vital signs and providing sedation as needed. Procedures such [...]
Most elderly patients have existing medical problems, which are su¬perimposed on age-related physiologic changes, complicating manage¬ment for the anesthesiologist. A thorough history and physical exami¬nation is an inlegral part of forniulaling an anesthesia plan lor the elderly patient. A review of previous hospital records or an interview with family members or friends can help define [...]
