Perioperative Care of the Elderly Patient

Older patients carry some of the highest risks of suffering an adverse event or death following anesthesia and surgery. They are inherently vulnerable, presenting with numerous comorbidities and reduced physiological reserve, requiring 'gero-centric' perioperative care for everything from routine eye surgery to major cardiac surgeries. Dementia, frailty, and the need for palliative care and pain management for the orthopedic patient are important areas requiring special consideration in this group. This book provides a general overview of these topics for those healthcare providers who may not have extensive knowledge of this patient population, while at the same time offering practical tips for the more experienced clinician. Chapters cover the spectrum of perioperative care including preoperative management of comorbid conditions, intraoperative anesthetic management, postoperative pain control, and a primer on advanced directive discussions. This book is appropriate not only for anesthesiologists but for any perioperative physician caring for the older patient.

    Encourages readers to expand preoperative assessments of frailty pre-surgery by providing practical examples of simple tests
    Provides topical, useful information for all perioperative physicians
    Tackles the ins and outs of implementation and maintenance

Table of Contents

Part I. Background:
1. Preoperative assessment of the elderly Sara E. Neves and Sheila Ryan Barnett
2. Ethical issues in perioperative care of the elderly: informed consent/informed refusal Gail A. Van Norman
Part II. General Health and Illness:
3. The perioperative management of hypertension in the elderly Jeffrey B. Dobyns and Thomas R. Vetter
4. Heart failure Rabya S. Saraf, Mario E. Montealegre and Robina Matyal
5. Dementia Angela Georgia Catic
6. Postoperative cognitive issues Christopher G. Hughes and Charles H. Brown, IV
7. Renal and metabolic aging Rita S. Patel and Michael C. Lewis
8. Frailty and functional assessment Dae Hyun Kim
Part III. Intraoperative Considerations:
9. The surgeon's perspective Cynthia E. Weber, Anthony J. Baldea and Frederick Luchette
10. Geriatric cardiac procedures John Mitchell
11. The aging valve Mario E. Montealegre, Rabya S. Saraf and Robina Matyal
12. Thoracic surgery in the elderly Elifce Cosar and Stephanie Cintora
13. Geriatric trauma: principles and anesthetic considerations Varun Rimmalapudi, Michael C. Lewis and Carol Ann B. Diachun
14. Major surgery in the elderly James M. Hunter, Jr and Thomas R. Vetter
15. Elective orthopedic surgery in the geriatric patient Lisa Kunze and Elizabeth Fouts-Palmer
16. Regional and neuroaxial anesthesia in the geriatric population Shachi C. Patel
17. Anesthesia for urologic and gynecologic surgery in the elderly Kristine E. W. Breyer
18. Cataract surgery in the elderly George A. Dumas and Gwendolyn L. Boyd
Part IV. Postoperative Issues:
19. Critical care of the elderly patient Abirami Kumaresan and Shazad Shaefi
20. Pain in the elderly Jason L. MeKeown and Thomas R. Vetter
21. Palliative care Mary Buss
22. Quality assessment and improvement in the elderly Marissa Wagner.

Sheila Ryan Barnett is Vice Chair of Perioperative Medicine, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Massachusetts, and Associate Professor, Anesthesiology, Harvard Medical School.

Sara E. Neves is an Instructor, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Massachusetts.

Contributors: Sara E. Neves, Sheila Ryan Barnett, Gail A. Van Norman, Jeffrey B. Dobyns, Thomas R. Vetter, Rabya S. Saraf, Mario E. Montealegre, Robina Matyal, Angela Georgia Catic, Christopher G. Hughes, Charles H. Brown, IV, Rita S. Patel, Michael C. Lewis, Dae Hyun Kim, Cynthia E. Weber, Anthony J. Baldea, Frederick Luchette, John Mitchell, Elifce Cosar, Stephanie Cintora, Varun Rimmalapudi, Michael C. Lewis, Carol Ann B. Diachun, James M. Hunter, Jr, Lisa Kunze, Elizabeth Fouts-Palmer, Shachi C. Patel, Kristine E. W. Breyer, George A. Dumas, Gwendolyn L. Boyd, Abirami Kumaresan, Shazad Shaefi, Jason L. MeKeown, Mary Buss, Marissa Wagner