Other Considerations
Posted by admin on November 18th, 2009Other 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 as HCG electrodes. Extra padding should be placed on operating tables, and care should be exercised in positioning extremi¬ties to avoid injury.
The elderly also have significant problems with perioperative tem¬perature regulation. Heal production is reduced as a result of their lower basal metabolic rate. Thinning of the skin and loss of subcutane¬ous fat make the skin a less effective insulator, so that body heat con¬servation is also impaired. The relative increase in body surface area wilh respect to body mass and the impaired vasomotor response in oldcrpersons predispose them to heat loss. Duringanesthesia, the ther¬moregulatory center in the hypothalamus is anesthetized; patients are pharmacologically paralyzed and given sympathetic blocking agents. Thus, heat production is prevented, and heat loss is promoted.
