Article information
RESUMEN
A medida que la población envejece, más pacientes geriátricos deben someterse a cirugías, bien sea electivas o urgentes. Dado que el envejecimiento es una experiencia única y personal, cada paciente que va ser sometido a cirugía debe abordarse de manera individual.
La valoración de la reserva funcional ha llegado a ser la piedra angular en el plan anestésico y es marcador pronóstico integral. Se dan pautas para su valoración, así como de la capacidad funcional, con el fin de minimizar los riesgos de la anestesia y la cirugía.
En la presente revisión se discuten los cambios de los órganos con la edad, el papel de las enfermedades intercurrentes como factores determinantes del riesgo, otros factores que incrementan el riesgo de complicaciones y los problemas perioperatorios que se pueden presentar, entre otros, los relacionados con el estado cognitivo.
Palabras clave:
envejecimiento
anestesia geriátrica
cirugía geriátrica
valoración preoperatorio del anciano
riesgo anestésico en geriatría
SUMMARY
As the population ages, more geriatric patients should undergo Esther elective or urgent surgery. Given that ageing is a unique and individual experience, each patient that goes to surgery, must be addressed on an individual basis.
The assessment of the functional reserve has become the cornerstone in the anesthetic plan and is the forecasting integral marker. Guidelines for its assessment are given, as well as its functional capacity, in order to minimize the risks of anesthesia and surgery.
In this review, changes in organs with age, the role of intercurrent diseases, and other factors that increase the risk of complications, perioperative problems that may arise, including those related to cognitive stes are discussed.
Key words:
elderly
geriatric anesthesia
geriatric surgery
perioperative assessment geriatrics
geriatric anesthetic risk
Full text is only aviable in PDF
REFERENCIAS
[1.]
United Nations, Department of Economic and Social Affairs, Population Division. World Population aging 2007. Fecha de consulta: abril de 2008. Disponible en: http://www.un.org/esa/population/publications/WPA2007/wpp2007.htm
[2.]
E. Grundy.
Epidemiología del envejecimiento. En: Brocklehurst's Geriatría.
Marbán, (2007),
[3.]
US Bureau Census.
[4.]
Censo 2005. Fecha de consulta: septiembre de 2007. Disponible en: www.dane.gov.co
[5.]
Comisión Económica para América Latina y el Caribe, CEPAL. América Latina y el Caribe: la dinámica demográfica de América Latina. Observatorio Demográfico 2007;3. Fecha de consulta: abril de 2008. Disponible en: http://www.eclac.org.
[6.]
J.M. Leung, L.L. Liu.
Current controversies in the perioperative management of the geriatric patients.
ASA Refresher Courses Lectures in Anesthesiology, 29 (2001), pp. 175-187
[7.]
J.A. Blansfield, S.C. Clark, M.T. Hofmann, J.B. Morris.
Alimentary tract surgery in the nonagenarian: elective vs. emergent operations.
J Gastrointest Surg, 8 (2004), pp. 539-542
[8.]
Interdisciplinary Leadership Group of the American Geriatrics Society.
A statement of principies: toward improved care of older patients in surgical and medical specialties.
J Am Geriatr Soc, 48 (2000), pp. 699-701
[9.]
J.H. López.
Fisiología del envejecimiento.
Impreandes Presencia, (1998),
[10.]
S. Muravchick.
Preoperative assesment of the elderly patient.
Anesthesiol Clin North Am., 18 (2000), pp. 71-89
[11.]
F.E. Sieber, R. Pauldine.
Anestesia for the elderly.
Anesthesia, 6th ed,
[12.]
S. Muravchick.
Geroanestesia.
Harcourt Brace de España, (1998),
[13.]
G.A. López.
Evaluación preoperatoria.
Geriatría,
[14.]
A.D. John, F.E. Sieber.
Age associated issues: geriatrics.
Anesthesiol Clin North Am., 22 (2004), pp. 45-58
[15.]
J.F. Gómez, C. Curcio.
Valoración integral de la salud del anciano.
Ed. Tizán, (2002),
[16.]
P. Timiras.
The nervous system: structural and biochemical changes.
Physiological basis of aging and geriatrics, Third edition,
[17.]
J.N. McAlpine, E.J. Hodgson, S. Abramowitz.
The incidence and risk factors associated with postoperative delirium in geriatric patients undergoing surgery for suspected gynecological malignancies.
Gynecol Oncol., 109 (2008), pp. 296-302
[18.]
G. Veliz-Reissmuller, H. Aguero, J. van der Linden, D. Lindblom.
Preoperative mild cognitive dysfunction predicts risk for postoperative delirium after elective cardiac surgery.
Aging Clin Exp Res., 19 (2007), pp. 172-177
[19.]
J. Kazmierski, M. Kowman, M. Banach, T. Pawelzyk, P. Okonsky.
Gen Hosp Psychiatry., 28 (2006), pp. 536-538
[20.]
EJ Masoro.
Aging.
Handbook of physiology,
[22.]
S.W. Krechel.
Anesthesia and the elderly patien,
[23.]
E. Lakatta, D. Levy.
Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. Part I. Aging arteries: A "set up" for vascular disease.
Circulation, 107 (2003), pp. 139
[24.]
G.A. Rooke.
Autonomic and cardiovascular function in the geriatric patient.
Anesthesiol Clin North Am., 18 (2000), pp. 31-46
[25.]
P. Timiras.
Cardiovascular alterations with aging: atherosclerosis and coronary heart disease.
Physiological basis of aging and geriatrics, Third edition,
[26.]
American College of Cardiology/American Heart Association Task Force.
Guidelines for the management of patients with atrial fibrillation.
Circulation, 114 (2006), pp. 700
[27.]
E. Zaugg.
Lucchinetti. Respiratory function in the elderly.
Anesthesiol Clin North Am., 18 (2000), pp. 47-58
[28.]
M.L. Janssen-Heijnen, H.A. Maas, S. Houterman, V.E. Lemmens, H.J. Rutten.
Comorbidity in older surgical cancer patients: Influence on patient care and outcome.
Eur J Cancer., 43 (2007), pp. 2179-2193
[29.]
R.B. Smith, M.A. Gurkowsky, C.A. Bracken.
Anesthesia and pain control in the geriatric patient,
[30.]
C. Baylis, R. Schmidt.
The aging glomerulus.
Sem Nephrol., 16 (1996), pp. 265
[31.]
I. Fehrman-Ekholm, L. Skeppholm.
Renal function in the elderly (>70 years old) measured by means of iohexol clearance, serum creatinine, serum urea and estimated clearance.
Scand J Urol Nephrol., 38 (2004), pp. 73-77
[32.]
C. Kelleher.
Alteraciones en el metabolismo del agua y de los electrolitos.
Brocklehurst's Geriatría,
[33.]
P. Phillips, B. Rolls, J. Ledingham.
Reduced thirst after water deprivation in healthy elderly men.
N Engl J Med., 311 (1986), pp. 753-758
[34.]
S. Giannelli, K. Patel, G. Windham, F. Pizzarelli, L. Ferrucci, J. Guralnik.
Magnitude of underascertainment of impaired kidney function in older adults with normal serum creatinine.
J Am Geriatr Soc., 55 (2007), pp. 816-823
[35.]
S.J. Melby, A. Zierer, S.P. Kaiser, T.J. Guthrie, J.D. Keune.
Aortic valve replacement in octogenarians: risk factors for early and late mortality.
Ann Thorac Surg., 83 (2007), pp. 1651-1656
[36.]
J.A. Alvarez, R.F. Baldonedo, I.G. Bear, N. Truán, G. Pire, P. Alvarez.
Emergency surgery for complicated colorectal carcinoma: a comparison of older and younger patients.
Int Surg., 92 (2007), pp. 320-326
[37.]
J.P. Liu.
Wiener-Kronish ¿iniciales? Perioperative anesthesia issues in the elderly.
Crit Care Clin., 19 (2003), pp. 641-656
[38.]
M.A. Buey, C.H. McLeskey.
Outcome after anesthesia and surgery in the geriatric patient.
Bailliere's Clinical Anesthesiology., 6 (1992), pp. 609-630
[39.]
K.E. McGoldrick.
The graying of America: anesthetic implications for geriatric outpatients.
ASA Refresher Course Lectures, (2006), pp. 212
[40.]
S. Muravchick.
The elderly outpatient: current anesthetic implications.
Curr Opin Anaesthesiol, 15 (2002), pp. 621-625
[41.]
S. Newman, J. Stygall, S. Hirani, S. Shaefi, M. Maze.
Postoperative cognitive dysfunction after noncardiac surgery: a systematic review.
Anesthesiology., 106 (2007), pp. 572-590
[42.]
L. Womack.
Cardiac rehabilitation secondary prevention programs.
Clin Sports Med., 22 (2003), pp. 135-160
[43.]
L. Joseph, J. Blumenthal, L. Katzel, A. Goldberg.
Successful aging: exercise training and cardiovascular health with aging.
Clin Geriatr., 13 (2005), pp. 40
[44.]
P. Tote, R.M. Grounds.
Performing perioperative optimization of the high-risk surgical patient.
BJA., 97 (2006), pp. 4-11
[45.]
ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy.
J Am Coll Cardiol, 47 (2006),
[46.]
L.A. Flesher, J.A. Beckeman.
Task Force on Practice Guideliness Evaluation, 116 (2007), pp. 418-499
[47.]
Care for Noncardiac Surgery: Executive Summary.
A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation;, (Oct. 23 2007),
Copyright © 2008. Revista Colombiana de Anestesiología
Article options