老年病人的麻醉管理

老年病人的麻醉管理

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时间:2019-07-17

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1、AnestheticManagementoftheElderlyPatientRaymondC.Roy,PhD,MDProfessor&ChairofAnesthesiologyWakeForestUniversityHealthSciencesWinston-Salem,NC,USA27157-1009http://www.wfubmc.edu/anesthesiaEducation:AnnualMeeting–AmericanSocietyofAnesthesiologistsHayflick’s

2、ViewofAging“Becausemodernhumans,unlikeferalanimals,havelearnedhowtoescapedeathlongafterreproductivesuccess,wehaverevealedaprocessthat,teleologically,wasneverintendedforustoexperience.”#OlderAmericans20002030>65yrs12.4%19.6%35mil71mil>80yrs9.3mil19.5milT

3、heOldest…..MAN120yrsWOMAN122GuinnessBookofRecordsGENERALANESTHETIC113BrJAnaesth2000;84:260LifeExpectancyatbirthUSA-1997WOMENCaucasian79.9yrsAfrican-American74.7MENCaucasian74.3African-American67.2LifeExpectancy,LifeSpan,&MaximumLengthofLifeMaximumLength

4、ofLife>120yrsLifeSpan85-100Naturaldeath(notraumaordisease)LifeExpectancy(USA)67-80Prematuredeath(trauma,disease)OldestSurgicalPatient?Oliver.BrJAnaesth2000;84:260Woman,113yrs,femoralfractureGeneralanesthesiaCVP,noarterial-lineExtubationinICUafter5hHospi

5、taldischargePOD23#Anestheticsper100Population?Clergue.Anesthesiology1999;91:1509(France)Ages(yrs)MenWomen35–448.913.255-6417.714.675-8430.223.6VascularSurgery–MortalityvsAgeFleisher.AnesthAnalg1999;89:849PerioperativeComplicationRatesinMedicarePatientsI

6、ntermediateRiskSurgery-42%Silber,Anesthesiology2000;93:152217,440general&orthopedicsurgeryLowRiskSurgery-3%Schein,NEnglJMed2000;342:16818,901cataractsurgeryAge&PerioperativeOutcomeWithadvancingageMoresurgeryMorbidityincreasesMortalityincreasesCause-dise

7、asevsage?Disease>agewhen<85yrsAgemay=diseasewhen>85yrsIncreaseASAPSwhen>85yrsPreoperativeConsiderationsPreoperativeAssessmentNoroutinepreoperativetestingStatinmyopathicsyndromesDiastolicdysfunctionDiabetesMellitusTighterglucosecontrolwithinsulinStoporal

8、hypoglycemicagentsWhyObtainPreoperativeTests?Screening–NOwithoneexceptionUrinalysisifhipsurgeryoracutelyillCook&Rooke,AnesthAnalg2003;96:1823Treatmenteffectiveness-YESBaseline–MAYBE,butoverusedRiskAssessment-YESValueofPreoperativ

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