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Perioperative pharmacology in elderly patients
Amrik Singh1, Joseph F Antognini
1Department of Anesthesiology and Pain Medicine, University of California, Davis, California 95616, USA.
Current Opinion in Anaesthesiology
|May 22, 2010
Summary
Caring for older patients undergoing surgery requires attention to postoperative cognitive decline (POCD) and judicious use of medications. While POCD is common, its long-term impact and prevention strategies remain unclear, and widespread beta-blocker use is not recommended.
Area of Science:
- Anesthesiology
- Geriatric Medicine
- Perioperative Care
Background:
- Global populations are aging, leading to increased surgical demands.
- Elderly patients present unique anesthetic challenges.
- Anesthesia care teams must address specific concerns in older surgical patients.
Purpose of the Study:
- To review key concerns in the perioperative care of elderly patients.
- To discuss postoperative cognitive decline (POCD) and delirium.
- To examine perioperative beta-blockade and drug use in older adults.
Main Methods:
- Literature review of recent studies on elderly surgical patients.
- Analysis of data regarding postoperative cognitive decline (POCD).
- Evaluation of evidence on perioperative beta-blocker therapy and drug effects.
Main Results:
- Postoperative cognitive decline (POCD) is a significant concern, affecting 30-40% of patients post-noncardiac surgery, though it may decrease by 3 months.
- Conflicting evidence exists regarding POCD's association with mortality.
- Perioperative beta-blocker therapy may increase stroke risk and its widespread use is questionable.
Conclusions:
- Elderly patients need specialized, attentive perioperative care.
- Older adults are highly sensitive to perioperative medications.
- While POCD is a recognized issue, preventative measures are not yet established. Beta-blocker therapy is indicated for specific patients, not general use.
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