Geriatric anesthesia
Started by epidural man
If you give anesthesia in my neck of the woods there will be many 90 year olds. I especially enjoy doing 95+ year olds as outpatients in a non affiliated ASC. I always question the wisdom of doing surgery of any kind on this age group (90+) but the patients and surgeon always seem to be on board with it.
Yes, I suspect that many more cases will be performed on 90+ year olds in the coming years.
Think 75 Is Too Old to Have Surgery? Think Again.
Why more senior adults than ever are having joint replacements, transplants and other major operations.
I did put in a spinal for a 90+ yo pt sometime ago, I was rather proud of myself.
Too Old to Operate? - Physician's Weekly
He was 94 years old and was in my office because his gallstones were becoming a problem. They had been diagnosed 2 years earlier when he had an ultrasound for an unrelated problem. At that time they were asymptomatic, and he was correctly advised to do nothing unless they started to cause...
www.physiciansweekly.com
"Many of my patients are over 90 years old. Our trauma unit regularly treats older patients. There is a 60+ initiative in the hospital system that tries to devise protocols for patients in the Medicare age range. We have recently begun to look at an 80+ initiative to recognize the different needs and risks of that increasingly common demographic.
My patient’s surgery went well. I kept him overnight in the hospital for safety sake, but found him walking on the ward the next morning when I made rounds. He went home that day and has done well since."
As my mentor and Chief, Dr. Ray Fletcher once told me, “It ain’t the model year, but the mileage that counts.”
Development and Evaluation of a New Frailty Index for Older Surgical Patients With Cancer
This cohort study evaluates the association of the Memorial Sloan Kettering–Frailty Index with established geriatric assessment and surgical outcomes for older surgical patients with cancer.
jamanetwork.com
Frailty as Potential Preoperative Risk Tool
Frailty evaluation has the potential to be a risk stratification tool for surgeons and their patients, according to the study authors. They wrote in their article: "Although not every patient needs an extensive frailty evaluation, every patient's preoperative risk should be known."
Measurement of frailty is available through multiple scoring classifications, but it is not yet widely accepted for hospitals to measure frailty preoperatively, Dr. Papaconstantinou said. He said their large health system is measuring frailty before surgical procedures in an attempt to improve outcomes by identifying at-risk patients and then using risk mitigation strategies, such as exercise, nutrition, and medication management.
If patients scheduled for a major or complex operation find out they have a high level of frailty, an option might be a "prehabilitation" program, Dr. Isbell suggested. A preoperative rehabilitation program, such as the American College of Surgeons Strong for Surgery, encourages patients to make physical and lifestyle changes aimed at improving the body's ability to withstand the stress of undergoing an operation.
"We think patients should discuss their frailty risk with their surgeon and the ways they can improve their health before their operation," Dr. Papaconstantinou said. "You would train for a marathon. Similarly, you have to get ready for an operation so you have the least possible risk of negative outcomes."
www.facs.org
Frailty evaluation has the potential to be a risk stratification tool for surgeons and their patients, according to the study authors. They wrote in their article: "Although not every patient needs an extensive frailty evaluation, every patient's preoperative risk should be known."
Measurement of frailty is available through multiple scoring classifications, but it is not yet widely accepted for hospitals to measure frailty preoperatively, Dr. Papaconstantinou said. He said their large health system is measuring frailty before surgical procedures in an attempt to improve outcomes by identifying at-risk patients and then using risk mitigation strategies, such as exercise, nutrition, and medication management.
If patients scheduled for a major or complex operation find out they have a high level of frailty, an option might be a "prehabilitation" program, Dr. Isbell suggested. A preoperative rehabilitation program, such as the American College of Surgeons Strong for Surgery, encourages patients to make physical and lifestyle changes aimed at improving the body's ability to withstand the stress of undergoing an operation.
"We think patients should discuss their frailty risk with their surgeon and the ways they can improve their health before their operation," Dr. Papaconstantinou said. "You would train for a marathon. Similarly, you have to get ready for an operation so you have the least possible risk of negative outcomes."
Frailty May Be a New Screening Criterion for Fitness for an Operation
Frailty is linked to more complications after an operation among adults of all ages.
D
deleted162650
I’ve done cases on a few 100+ year olds. I always tell myself “Well, they’ve lived 102 years, I’m probably not gonna be what kills them.”
That kind of people age here in Iraq, are mostly soaked with rose water by their grandsons on their graves in the cemetery since a decade !
We induced 80+ over here, but on rare occasions, mostly for hip surgeries and colon stuff!
The other day, we had a guy 89 years with ICH, and he survived it with 28 days in the ICU + ETT, that was a miracle to remember!
We induced 80+ over here, but on rare occasions, mostly for hip surgeries and colon stuff!
The other day, we had a guy 89 years with ICH, and he survived it with 28 days in the ICU + ETT, that was a miracle to remember!
As @BLADEMDA said absolute age is irrelevant. Always amusing to meet a 50 year old that looks worse in real then the next 90 year old.
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Personal record was 104 for emergency eye evisceration. Poor functional status. It was not fun. Did a 102 year old in the same week. Strange stretch.
Did a 94 y/o AVR 7-8 years ago.
He did great and is still around.
He did great and is still around.
I had the most spry 102 year old the other day. Healthier oddly enough than most of my usual patients.
He walked unassisted into preop, had no issues interop, d/c home same day.
Agree with salty above that there is usually a reason someone gets to that age.
I get 90 year olds often. They do well. But I guess that’s what training in Florida gets you.
He walked unassisted into preop, had no issues interop, d/c home same day.
Agree with salty above that there is usually a reason someone gets to that age.
I get 90 year olds often. They do well. But I guess that’s what training in Florida gets you.
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In my experience, with this age group, they may have "done well" after you drop them off in the pacu, but you see the issues in the weeks/months following the surgery
D
deleted87051
Yep. What’s the life expectancy of a healthy 102yo?
Agree. I’m sure some are fine. But I cringe with some of the surgeries I see done.
When I talk to the family members of these geriatric patients, so many times they will cite a surgery as the point after which the "previously healthy" baseline took a nose dive
Great chart.
Ive hit a trend of elderly patients with a good amount of co-morbidities.
One day they were sick enough that I used etomidate on all of my inductions.
One day they were sick enough that I used etomidate on all of my inductions.
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Did a 96 Y/o CABG x3 a few years back.
3 weeks later he came back with esophageal cancer, but it's not metastatic and will be probably do fine if he gets an esophagectomy.
D
deleted697535
Holy sh1t an esophagectmy in a 96 yo weeks after their cabg. Wow...
I expect a lot more interest in prehabilitation and neurocognitive outcomes with an increasingly elderly population.
jamanetwork.com
Honestly one of the few good things to come from the "preoperative home" movement.
Effect of Cognitive Prehabilitation on Postoperative Delirium in Older Adults Undergoing Major Noncardiac Surgery
This randomized clinical trial examines whether cognitive prehabilitation reduces the incidence of postoperative delirium among older adults.
jamanetwork.com
Honestly one of the few good things to come from the "preoperative home" movement.
One thing I will add about the subject of the extreme geriatric patient. It is always great to talk to these people about their backgrounds, since theirs was truly the “greatest generation” of this country. They survived the Great Depression, WWII and were witness to countless other amazing moments in our history. I took care of a WWII vet who landed on D day (yesterday by the way) and was blown up by an artillery shell. His life was saved when a large piece of shrapnel the size of a fist lodged itself into the stock of his rifle. He said he fought the rest of the war with that gun and felt it was his good luck charm. Absolutely incredible talking to that guy.
I just talked to a guy who had ether when he was a kid
