Effects of Anesthetics to the Elderly 11

Effects of Anesthetics to the Elderly 11

Introduction

Due to the improvements on the anesthetics and techniques being currently used in the surgery, the level of mortality in the population being referred for the surgical operations has considerably continued to reduce. However, it has not been surprising to realize that despite these developments, the level of postoperative mortality and complications related to the anesthetics has; in the elderly patients has remained high when compared to the patients who are younger (this mortality mostly affects those beyond 70 years of age). Although the techniques of anesthetics medical procedures used in both the elderly and the young are similar, there has been a requirement for further consideration in the elderly patients. This factor has been due to the fact that in addition to the natural and physiological changes related to the factor of age, the co- morbidity that is associated with the people at their old age is usually high, in addition to high energy in old age which results to the acetabulum injury after the surgical operation (Herscovici, 2010). These factors exposes the elderly patient to a risk that is even greater in terms of postoperatively adverse outcome, therefore calling for the need of the anesthetists being involved with these patients to be aware of the effects that are very likely in the process of taking the elderly patients through anesthetics in the surgical procedures.

This article examines the effects of administering anesthetics to the elderly patients as a way of ensuring the management of the acute pain. In order to understand this, this article also has an overview of the aging psychological function. The article is based on the understanding that the therapy used in the management of the pain, in addition to the negative effects; with an inclusion of regional anesthesia have a great help (positive effects) in the reduction of the risks associated with the negative influences in these elderly patients as well as reduction of the postoperative anesthesia as well as the cognitive dysfunction.

Aging in relation to the psychological function

Passot et al (2005), notes that the increase of the elderly patients will continue signaling for the need for the anesthesia techniques as well as the surgical procedures. This is supported by Arnold (2007), who notes that this increase in the elderly anesthetic surgical cases has been as a result of increased life expectancy. In addition, the need to consider the aging and associated disease physiological changes is important due to the fact that there are usually diminished researve complications in these patients. The management of anesthesia that is optimal in the elderly patients is based on the understanding and knowledge of the changes that are related to the age in the physiology, anatomy as well as the pharmacology agent responses. Thomas (2009) highlights the importance of distinguishing between the physiological alterations that are normal in the cardiovascular, nervous and hepato- renal system as well as the phathophysiological changes that are related to the diseases. An approach that is generally aimed at optimizing the management of the pain that occurs before the operation process in the geriatric patients requires the consideration of the complication that are preoperative which are in most cases associated to the normal procedures of surgery and assessment of any benefits that can be potential in relation to the anesthetic medical procedure. The most common cardiovascular complications that are usually observed in the elderly patients and whose occurrence is most frequent in the general situation as well as in the orthopedic surgical settings are generally the pulmonary, neurologic and cardiovascular complications. There are both theoretical and established indications which support the concept that an effective and safer option of anesthesia for the elderly are provided by the regional anesthesia.

According to Thomas (2009), the geriatric population is usually perceived to be a group that is heterogeneous and its response the techniques and medications of anesthesia is usually perceived to be quite different in comparison the patients that are younger. Thomas adds that there is usually diminished reserve and reduction in function in the pulmonary and cardiovascular systems which can eventually result to the reduction in the responses that are appropriate to the preoperative stress. The changes in the renal and hepatic function usually results in medications altered clearance that may eventually result in increased sensitivity to the drugs. Observation of pharmacokinetic changes can be as a result of increase in the body fat as well as reduction of the body water and mass of the muscle. Complaints in relation to the preparative memory in most cases are usually signals of early dementia. What usually happens to these patients as well as those with low levels of education together with cerebral vascular accident history is that in most cases, they become usually become predisposed to POCD (postoperative cognitive dysfunction). In the preoperative period, the elderly patients usually have a high vulnerability to decline in the cognitive and delirium, which has been linked to the increasing level of mortality and morbidity. There should therefore be a consideration of these risk factors (especially the advanced age), in the effort to reduction of the contributions that are possible as a result of exposure to excessive drugs, general anesthesia and opioid medications.

Erdil et al (2009), notes that the most common side effect of the central neural block is bradycardia and systemic hypotension. The harmful effects of marked hypotension may be extreme, especially if the affected patient’s cardiac reserve is limited (Minville et al, 2009). To these elderly patients, the central nerves and peripheral degeneration that is gradual results in changes in the thoracic vertebrae lumbar anatomical configuration and reduction in the volume of the cerebrospinal fluid which may eventually result in block level that is sympathetic (Erdil et al, 2009).

Anesthetic outcomes

When regional anesthesia is used in the elderly patients, there is usually a remarkable improvement. The biggest question in the surgical world has been the viability of using the regional anesthesia instead of the general anesthesia. In both cases anyway, the profound effects have occurred leading the medical field not being able to appraise any of the two as completely safe when administered to the elderly patients. The debate on which type of anesthesia to administer has ranged in most instances in the medical field, with less clear answers being found. However, what many concur with is that the surgical outcome is usually influenced by the factors such as the preoperative quality of care, general anesthesia and regional anesthesia method, the surgical procedure as well as the patient that is going through the anesthetic medical procedure.

In most of the operations, one of the complications that have very commonly been reported has been the postoperative pain. According to a retrospective study conducted on a large scale basis by McGrath et al (2004; Thomas, 2009), there has been a clear demonstration that the level of pain in the orthopedic, neurological and general surgeries is usually postoperatively higher. There has generally been limitation in the ability to enhance the management of the pain after the surgery, as well as the determination of the procedure types that the ambulatory centre can perform which has been associated with high rate of admission to the hospitals, long stay in the hospital past the required time, high possibility of development of pain conditions that are chronic as well as the state of chronic pain exacerbation.

While the management of the pain is essential, a prolonged and excellent analgesia that is postoperative is usually provided by anesthesia which usually results in patient morbidity that is more comfortable and quicker as well as a reduction in the opioid requirements, facilitation of physical therapy participation and expedition of the activities that returns the patient to normalcy. As a result to these characteristics, the recovery process is usually faster coupled with the improvement in the preoperative outcomes which is usually portrayed by increase in the satisfaction to the patient and the family from the surgical procedure. As a result of the anesthetics combination with the regimens, there is basically facilitation to optimal anesthesia goals, a functional outcome that is enhanced in addition to improvement in the elderly patient’s life quality.

Postoperative cognitive dysfunction

Multiple morbidities in addition to presentation of high preoperative levels of risk are common with the elderly patients (Arnold, 2007). This complication usually results from non cardiac and cardiac surgical operations in the patients that are elderly although it has been hard to understand its mechanisms. The assumption that remains is usually based on the understanding that the stress response reduction, postoperative pain and the consumption of the opioid provided in the anesthetic process would result in reduced postoperative cognitive dysfunction incidences. The neuraxial blockade effects to cognitive function have in most cases been studied with the analysis resulting to evaluation of the general anesthesia versus the neuraxial anesthesia on the postoperative cognitive dysfunction, although there has not been randomized studies in which the peripheral nerve blocks effects have been compared with the general anesthesia on the postoperative cognitive dysfunction (Arnold, 2007).

The negative influence and impact on the life quality has raised concern due to the high postoperative cognitive dysfunction incidence in the elderly patients. The sleep impairment that has been significantly witnessed in these patients as well as the disturbances caused by postoperative sleep have a high probability of presenting in the elderly patient with high pain levels which can lead to recovery difficulty or prolonged recovery. Sleep disturbances may not be the only cause of pain but there may be contribution of other factors which may include the agents used in the inhalation, age increase, the apioids and the stress resulting from surgery as well as the environmentally related factors; many of which could be reduced through the use of regional anesthesia. The sleep impairments; irrespective of the reason for occurrence, has a possibility of resulting to reduction in the quality of life related to health, increase in the postoperative fatigue as well as the postoperative cognitive dysfunction.

The resumption ability to the daily activities that are normal similar to the state before the operation procedure remains a postoperative result that is relevant in addition to being one postoperative cognitive dysfunction devoid, morbidity and functional impaired status. The various complications and symptoms that result from the surgery process have a high potential of impending the normal daily activities resumption for the elderly patients in addition to the negative influence on the capacity to function. With the regional anesthetics, the patients are basically able to have early mobilization resumption together with physical therapy benefits resulting in better motion ranges and less stiffness in the joints which is basically a signal to better results.

According to Robert et al (2005), there is in most cases an experience of postoperative delinquency that is transient in the elderly patients in addition to postoperative cognitive dysfunction in the long term. These effects, although distressful to the patients have in most cases been overlooked despite the fact that they have been very common in the elderly patients. In addition to this, Robert (2005) notes that interval delirium has been a very common type of delirium that has been witnessed after the process of surgery, with its occurrence being common at between two and seven days after the anesthetic surgical operation. The characteristic of delirium includes cognition and consciousness changes (memory impairment and disorientation) over a short period of time. There is also prominence of the emotional disturbances coupled with symptoms with implication of anger, fear, irritability, anxiety and depression. The interval rate of delirium occurrence in most cases is usually in the range of between 9 % and 26 %. This risk in the elderly patients is usually high accounting to the level of 50 % (Robert, 2005)

The pulmonary morbidity

The significance of the pulmonary morbidity has been realized after the thoracic and upper abdominal surgery. The anesthetic surgery has resulted in most cases to high incidences of improper functioning of the pulmonary which has in most cases strongly affected the respiratory therapy. The normal functioning of the pulmonary in the elderly patients can be impaired by the opioid and pain therapy which in most cases results in hypoxia as well as the pulmonary infection as a result of the effect on the coughing, expansion of the chest and breathing problems (Arian, 2005).

In addition to the pulmonary morbidity, the cardiovascular complications have remained to be one of the major complications that have been of concern to the elderly surgical operation patients, together with associated risk factors which have raised the concern for the need of consideration. The study results that have been controversial have resulted in various suggestions on the types of anesthetics as well as the cardiac influences that are direct on the elderly patient’s surgery. The various results that are conflicting as well as the flaws in the study results may assist in explanation, but there must be consideration of the advantages of anesthesia (especially the regional anesthesia) as an approach which is aimed at handling the care of the elderly patients undergoing the anesthetic surgical operations. Various changes (functional and morphological) are witnessed in the cardiovascular system, which have resulted to clinical implications that are important for the elderly patient surgical treatment toward considering postoperative management of pain using the anesthesia.