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  Anesthesia for Senior Citizens  
 

 

If you or a family member of advancing years is scheduled to undergo surgery, then the following section may offer answers to some of the questions and concerns you may have concerning anesthesia. It is important to realize that most elderly patients tolerate anesthesia very well. It is estimated that over 7 million surgeries are performed on patients older than 65 years in the US each year. Some surgeries are performed emergently while others are elective and are aimed at improving the overall quality of the patient’s life. Many of these patients have particular medical problems which may complicate anesthesia, but a healthy elderly patient has virtually no increase in risk from anesthesia.

Will my body tolerate the anesthesia drugs?
Most anesthesia drugs have a greater effect on elderly people than they do in younger people. Your brain requires less medication to put you to sleep, and many of the other anesthetic drugs will last for longer because your liver and kidneys become less efficient at removing them from your system. Most drugs are therefore given slowly, in gradually increasing dosages until the desired effect is achieved. During surgery, your anesthesia team will carefully monitor you for the effects of these drugs and will adjust the amount you receive. Great care is taken at the end of surgery to make sure that you have recovered completely from the effects of the anesthesia medications.

Will my heart disease affect the anesthesia?
High blood pressure, coronary artery disease and heart failure occur more frequently in the elderly patient. Changes in blood pressure can occur more easily in the elderly due to an increased sensitivity of blood vessels to the anesthesia medications. Therefore, special care is required to prevent any unnecessary stress to the elderly patient. Your anesthesiologist will evaluate carefully your particular conditions and will prescribe a plan designed to help you safely through surgery. Depending on the severity of your disease and expected surgery, he or she may suggest additional cardiac monitors to ensure your safety during and after surgery.

Will my lung disease affect the anesthesia?
Smoking, emphysema, asthma and COPD all affect anesthesia, and it is always a good time to stop smoking! As we get older, even healthy elderly patients will experience a decrease in lung function. General anesthesia tends to exaggerate these effects, as does surgery on the abdomen, which interferes with your ability to cough. Some elderly patients benefit from additional oxygen for a day or two after surgery. Also, good pain control helps patients to cough and breathe deeply. Some surgeries that can be performed without general anesthesia by using regional anesthesia like a spinal or arm block. These can be excellent choices in patients with severe lung disease.

Will anesthesia have permanent effects on my memory?
While some elderly patients can experience confusion in the period following their operation, these are usually only temporary. There are many factors involved, including responses to anesthesia medications, metabolic changes following surgery, infections, fevers and unfamiliar surroundings. Your anesthesia team will choose techniques and drugs to minimize these side effects while keeping you as safe and comfortable as possible.

What will my anesthesiologist want to know before surgery?

Your anesthesiologist will review your medical history. She or he will pay particular attention to any significant medical problems, what medications you are taking, any drug allergies, and your previous surgeries and anesthetics. On the basis of the evaluation, your anesthesiologist will tell you the plan for the anesthetic, and will discuss any other suitable alternatives together with the risks. This is your chance to discuss the plan and to have any questions you may have answered.

Should I take my medications before surgery?
You should take most of your regularly scheduled medications with a sip of water before you come to the hospital. This is particularly important for heart and blood pressure medications, and for acid reflux (“heartburn”) medicines also. Patients taking blood-thinners or diabetes medication should discuss these medicines with your surgeon and anesthesiologist before surgery. You will be given specific instructions in these circumstances.

What does General Anesthesia involve?
During General Anesthesia, the patient is totally unconscious. The patient receives anesthesia medication initially through an IV to go off to sleep. Anesthesia is then maintained with anesthesia gases together with a combination of sedative, pain relievers and muscle relaxing drugs. Some surgeries require the placement of a breathing tube in the patient’s windpipe. This is placed after the patient is asleep, and usually removed before the patient awakens. Following surgery, the patient is transferred to the recovery unit and allowed to wake up completely before going home or being transferred to their hospital room.

What does Spinal or Epidural Anesthesia involve?

Both Spinal and Epidural Anesthesia work by numbing the nerves as they enter the spinal cord. Local anesthetic medication is injected under the skin between the bones in your back. The resulting numbness allows a variety of surgical procedures in the lower part of the body. While Spinal and Epidural Anesthesia are often used along with sedation or General Anesthesia, the numbness from the local anesthetic drugs permits the use of much smaller doses of other drugs to maintain General Anesthesia. As a result, patients wake up faster from anesthesia and may experience fewer side effects. Epidural anesthetics also permit the anesthesiologist to administer pain medications via a small plastic tube in the epidural space for several days postoperatively. The pain relief is excellent and helps patients to cough, breathe deeply and to get out of bed earlier during their recovery.

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