Geriatric anesthesia

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epidural man

epidural man

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Some weeks ago, I had to do anesthesia on a 99 y/o. I thought...well, I will never do anesthesia on someone older than this.

Well today - induced a 105 y/o.

Is it a trend?

I suspect if you did anesthesia in Osaka Japan, this would be a regular thing.
 
epidural man said:
Some weeks ago, I had to do anesthesia on a 99 y/o. I thought...well, I will never do anesthesia on someone older than this.

Well today - induced a 105 y/o.

Is it a trend?

I suspect if you did anesthesia in Osaka Japan, this would be a regular thing.
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If you give anesthesia in my neck of the woods there will be many 90 year olds. I especially enjoy doing 95+ year olds as outpatients in a non affiliated ASC. I always question the wisdom of doing surgery of any kind on this age group (90+) but the patients and surgeon always seem to be on board with it.

Yes, I suspect that many more cases will be performed on 90+ year olds in the coming years.


www.hopkinsmedicine.org

Think 75 Is Too Old to Have Surgery? Think Again.

Why more senior adults than ever are having joint replacements, transplants and other major operations.
www.hopkinsmedicine.org www.hopkinsmedicine.org
 
www.physiciansweekly.com

Too Old to Operate? - Physician's Weekly

He was 94 years old and was in my office because his gallstones were becoming a problem. They had been diagnosed 2 years earlier when he had an ultrasound for an unrelated problem. At that time they were asymptomatic, and he was correctly advised to do nothing unless they started to cause...
www.physiciansweekly.com www.physiciansweekly.com


"Many of my patients are over 90 years old. Our trauma unit regularly treats older patients. There is a 60+ initiative in the hospital system that tries to devise protocols for patients in the Medicare age range. We have recently begun to look at an 80+ initiative to recognize the different needs and risks of that increasingly common demographic.

My patient’s surgery went well. I kept him overnight in the hospital for safety sake, but found him walking on the ward the next morning when I made rounds. He went home that day and has done well since."

As my mentor and Chief, Dr. Ray Fletcher once told me, “It ain’t the model year, but the mileage that counts.”
 
Frailty as Potential Preoperative Risk Tool

Frailty evaluation has the potential to be a risk stratification tool for surgeons and their patients, according to the study authors. They wrote in their article: "Although not every patient needs an extensive frailty evaluation, every patient's preoperative risk should be known."

Measurement of frailty is available through multiple scoring classifications, but it is not yet widely accepted for hospitals to measure frailty preoperatively, Dr. Papaconstantinou said. He said their large health system is measuring frailty before surgical procedures in an attempt to improve outcomes by identifying at-risk patients and then using risk mitigation strategies, such as exercise, nutrition, and medication management.

If patients scheduled for a major or complex operation find out they have a high level of frailty, an option might be a "prehabilitation" program, Dr. Isbell suggested. A preoperative rehabilitation program, such as the American College of Surgeons Strong for Surgery, encourages patients to make physical and lifestyle changes aimed at improving the body's ability to withstand the stress of undergoing an operation.

"We think patients should discuss their frailty risk with their surgeon and the ways they can improve their health before their operation," Dr. Papaconstantinou said. "You would train for a marathon. Similarly, you have to get ready for an operation so you have the least possible risk of negative outcomes."


www.facs.org

Frailty May Be a New Screening Criterion for Fitness for an Operation

Frailty is linked to more complications after an operation among adults of all ages.
www.facs.org www.facs.org
 
That kind of people age here in Iraq, are mostly soaked with rose water by their grandsons on their graves in the cemetery since a decade !
We induced 80+ over here, but on rare occasions, mostly for hip surgeries and colon stuff!
The other day, we had a guy 89 years with ICH, and he survived it with 28 days in the ICU + ETT, that was a miracle to remember!
 
Personal record was 104 for emergency eye evisceration. Poor functional status. It was not fun. Did a 102 year old in the same week. Strange stretch.
 
I had the most spry 102 year old the other day. Healthier oddly enough than most of my usual patients.

He walked unassisted into preop, had no issues interop, d/c home same day.

Agree with salty above that there is usually a reason someone gets to that age.

I get 90 year olds often. They do well. But I guess that’s what training in Florida gets you.
 
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I did a hemi on a 102 yo. Guy was amazing. Survived an open AAA at 92.
One day on call I did 3 hips all over 90. All did well but heard one didn’t get out of rehab.
 
Ive hit a trend of elderly patients with a good amount of co-morbidities.
One day they were sick enough that I used etomidate on all of my inductions.
 
Actually love taking care of this group. They are all thin, have great airways and never buck on extubation. Mostly for fractured hips or bowel stuff. Very few elective procedures....
 
A few weeks ago I took care of a 102 year old for a hip fracture in the afternoon. The case I started my day with? A 2 day old ex-26 weeker. As they say from diapers to diapers.
 
sevoflurane said:
Did a 94 y/o AVR 7-8 years ago.
He did great and is still around.
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Did a 96 Y/o CABG x3 a few years back.

3 weeks later he came back with esophageal cancer, but it's not metastatic and will be probably do fine if he gets an esophagectomy.
 
dchz said:
Did a 96 Y/o CABG x3 a few years back.

3 weeks later he came back with esophageal cancer, but it's not metastatic and will be probably do fine if he gets an esophagectomy.
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Holy sh1t an esophagectmy in a 96 yo weeks after their cabg. Wow...
 
One thing I will add about the subject of the extreme geriatric patient. It is always great to talk to these people about their backgrounds, since theirs was truly the “greatest generation” of this country. They survived the Great Depression, WWII and were witness to countless other amazing moments in our history. I took care of a WWII vet who landed on D day (yesterday by the way) and was blown up by an artillery shell. His life was saved when a large piece of shrapnel the size of a fist lodged itself into the stock of his rifle. He said he fought the rest of the war with that gun and felt it was his good luck charm. Absolutely incredible talking to that guy.
 
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