Anesthesia in the elderly
introduction
Anesthesia is a burden on the body at any age. With older people, however, special things have to be considered when planning anesthesia. On the one hand, older people also have more secondary diseases that have to be included in anesthesia planning. As well as any medication they take. Older people are also at increased risk of temporary confusion after the operation. In technical terms, this is called postoperative delirium.
What are the special features?
In older people, anesthesia can pose completely different risks than in younger people. Therefore, before each operation, it should be weighed up whether the benefits of the operation outweigh the risks, or whether there are gentler procedures that may lead to the same result. Elderly people also often have a number of secondary diseases that must be treated with medication.
Therefore, when planning anesthesia, it is important to see which medication has to be discontinued, exchanged or added before the operation. Furthermore, the heart and lung function (see also: Heart disease) to make sure the body can withstand the stress of an operation and that ventilation is working.
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What are the risks?
Because hardly any older person is completely healthy, the secondary diseases can become problematic for the anesthesia. Particular mention should be made of diseases of the cardiovascular system or diabetes. People with these conditions are more likely to have complications during anesthesia. Another risk arises from the fact that the anesthesia cancels out important protective reflexes.
It can then happen that the stomach contents rise and are inhaled. If the stomach contents are in the lungs, it can lead to pneumonia. That is why it is so important to be sober before anesthesia in order to keep this risk as low as possible. If the dental status of older people is in need of renovation, there is a risk that the teeth could be injured when the ventilation loop is inserted. This rarely happens, but the risk is increased with bad teeth.
You can find more information about the possible risks of anesthesia in our article: Stages of anesthesia
What can be the after-effects of anesthesia in the elderly?
An aftereffect that is more common in older people is temporary confusion or disorientation after surgery. In addition, an older body needs a little more time to recover from the anesthesia, so that there can be a temporary weakness. However, it is very important to get mobile again as soon as possible after the anesthesia and the operation in order to avoid complications of being confined to bed.
In addition, the classic after-effects of anesthesia, such as nausea and vomiting, can also occur in older people. Women in particular are affected by this aftereffect. The ventilation tube can cause hoarseness and slight pain in the neck area for a few days after the anesthesia. A feeling of coldness and muscle tremors after the operation is also possible. This aftereffect, however, quickly subsides.
For more detailed information, read our article Aftermath of anesthesia.
confusion
The risk of post-operative confusion increases with age. Other negative influencing factors are secondary illnesses such as diabetes, cardiovascular diseases or depression. In addition, patients who take medication for depression or sedatives (benzodiazepines) have a comparatively higher risk of suffering from such confusion.
The secondary diseases in particular can promote inflammatory processes in the brain during anesthesia. This then has damaging effects on the nerve cells in the brain. As a countermeasure, one tries to keep the anesthesia as flat as possible. If confusion occurs after anesthesia, countermeasures should be taken as soon as possible with medication and other measures, as long-term confusion has a bad effect on the prognosis.
What can be done to reduce the aftereffects?
The anesthetist can control the depth of the anesthesia during the operation, through the medication or the anesthetic gas. If there are risk factors that encourage confusion, the anesthetist would try to keep the anesthesia as flat as possible. This is a balancing act because the anesthesia must not be too shallow at the same time so that the patient does not notice the operation.
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If there is any confusion after the anesthesia, relatives can be of great help. Just their presence gives the patient a familiar and secure feeling. The relatives are encouraged to calmly explain to the patient where he is and what has happened. Aids such as watches or glasses can also help the patient to find their way around their unfamiliar surroundings.
The day-night rhythm is often mixed up in these patients. It therefore helps to support the patient in falling asleep in the evening through measures such as reading aloud. In justified cases, you can still give low-dose medication to combat confusion. In general, after an operation, rapid mobilization can help against many after-effects of the anesthesia and also the operation.
