Neurosurgical Anesthesia for the Elderly: Is Age Really Just a Number?
Advances in medicine have increased the survival and health of our population in recent years. The result is an increasing age trend that has led to growth in the surgical sector overall and in the neuroscience service line. The geriatric patient with agi
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Neurosurgical Anesthesia for the Elderly: Is Age Really Just a Number? David A. Wyler, Elizabeth M. Gabrielli, and W. Andrew Kofke
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Introduction
Innovation in medicine has increased the survival and health of our population in recent years. The increasing age trend has grown the neurosurgical sector. Similarly, this expansion has led to the advent of many innovative procedures now available to seniors. From minimally invasive spine surgery to deep brain stimulation implant for Parkinson’s disease, the innovation in neurosurgery has sparked new anesthetic techniques to best accommodate the growth in technology. For instance, awake craniotomy is now offered to elderly patients to determine which areas of the brain are responsible for abnormal functions and which ones are eloquent and must be avoided. The anesthetic technique should be tailored to best achieve these goals regardless of choice of anesthetic [1]. The fact is however that age alone is an independent risk factor for perioperative morbidity and mortality [2]. The geriatric patient with aging organ systems combined with neurologic disease presents unique challenges to the neuroanesthesiologist. It is important to discover through this chapter that the senescent brain does not age by itself independently. Rather multiple connections exist between each human system that influence the aging process in the brain and then consequently become further complicated with disease. Furthermore, not all patients age in equal form. Variability between aging patterns from patient to patient also makes it difficult to D.A. Wyler, MD Department of Anesthesiology & Critical Care, Neurosurgery, Jefferson Hospital of Neuroscience, Thomas Jefferson University, Philadelphia, PA, USA e-mail: [email protected] W.A. Kofke (*) • E.M. Gabrielli, MD Department of Anesthesiology and Critical Care, Neurosurgery, University of Pennsylvania, 7 Dulles Building, 3400 Spruce St, Philadelphia, PA, USA e-mail: [email protected]; [email protected] © Springer International Publishing Switzerland 2017 M. Berhouma, P. Krolak-Salmon (eds.), Brain and Spine Surgery in the Elderly, DOI 10.1007/978-3-319-40232-1_4
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predict which organ systems to key in on while in the care of the perioperative physician. The aim of this chapter is to review the perioperative challenges of the elderly patient as they pertain to neurosurgical anesthesia. We will explore the perioperative experience for older adults and identify risk factors most relevant to the neurosurgical patient. “Aging is a progressive and irreversible phenomenon characterized by degenerative changes in the structure and functional reserve of the organs and tissues” [3]. Obviously, in the modern era of medicine, polypharmacy coincides with advancing physiological age. Preoperatively, the neuroanesthesiologist is tasked with evaluating each of these organ systems and coinciding home medications paying special attention to their interactions with anesthetic drugs. In prep
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