Note: Page numbers of article titles are in boldface type. A Adverse drug events, polypharmacy and perioperative considerations in elderly patients, 377 389 Age, and risk of postoperative urinary retention, 474 475 Aging, cardiovascular, and diastolic dysfunction, 497 517 normal, effect on delayed arousal, 430 436 pharmacologic effects of, beta-blockers and, 591 592 Airway management, in DBS lead placement for Parkinson s disease, 402 Alzheimer s disease, cholinesterase inhibitors and, perioperative considerations for patients on, 387 Ambulatory surgery, discharge criteria for, and risk of postoperative urinary retention, 477 478 Analgesia, and postoperative pain, role in development of urinary retention, 472 Anesthesia, in geriatric patients, 377 603 acute mesenteric ischemia, 551 567 aortic valve stenosis, 519 532 atrial fibrillation in, 417 427 beta-blockers, 581 597 delayed arousal in, 429 450 diastolic dysfunction and cardiovascular aging, 497 517 fat embolism, 533 550 in patients with skin breakdown, 599 603 informed consent and ethical management, 569 580 Parkinson s disease and deep brain stimulator placement, 391 415 polypharmacy and perioperative medications, 377 389 postoperative cognitive dysfunction, 485 496 postoperative delirium, 451 464 postoperative urinary retention, 465 484 Anesthetic technique, role in development of postoperative urinary retention, 469 471 Anticholinergic activity, of medications in older patients, 381 382 Anticoagulation, for atrial fibrillation in the elderly, 423 424 Antiparkinson medication, perioperative considerations for elderly patients on, 386 Aortic valve stenosis, in elderly patients, 519 532 anesthesia for noncardiac surgery in patients with, 527 528 classification criteria, 522 modulating therapies and strategies in, 524 526 natural progression and course of, 523 524 pathophysiology, 520 522 physical examination and clinical presentation, 523 replacement, 526 527 Arousal, from anesthesia, delayed, see Delayed arousal. Anesthesiology Clin 27 (2009) 605 615 doi:10.1016/s1932-2275(09)00086-x anesthesiology.theclinics.com 1932-2275/09/$ see front matter ª 2009 Elsevier Inc. All rights reserved.
606 Arrhthymias, atrial fibrillation in the elderly, 417 427 Ascending arousal system, nonthalamic branch, 432 433 thalamic branch, 431 432 Atrial fibrillation, in cardiac surgery, chronic use of beta-blockers in, 583 in the elderly, 417 427 case studies, 417 418 etiology and pathophysiology, 419 incidence and prevalence, 418 419 management, 419 425 anticoagulation, 423 424 catheter ablation, 424 echocardiography, 423 electrical cardioversion, 420 MAZE procedure, 422 pacing, 422 423 pharmacologic interventions, 420 rate control, 420 422 rhythm control, 422 scenarios arising during perioperative period, 424 425 Autonomy, patient, promoting during informed consent process, 573 574 B Beers criteria, for inappropriate prescribing in the elderly, 381 Beta-blockers, perioperative use in elderly patients, 581 597 common comorbidities benefiting from chronic use of, 582 584 atrial fibrillation in cardiac surgery, 583 congestive heart failure, 583 coronary artery disease, 584 hypertension, 583 584 pharmacologic effects of aging, 591 592 prophylactic use of, 584 591 contraindications, 590 591 duration of, 590 overview of studies on, 584 588 target population for, 585 timing, dosage, and choice of, 589 590 treatment effect, 589 recommendations, 592 Bladder catheterization, duration of, and risk of postoperative urinary retention, 476 Blood pressure, control of, in acute mesenteric ischemia, 600 Brain imaging, in assessment of postoperative cognitive dysfunction in the elderly, 492 C Cardiac arrhythmias, atrial fibrillation in the elderly, 417 427 Cardiac surgery, in patient with diastolic dysfunction, 505 509 Cardiovascular aging, diastolic dysfunction and, 497 517 Cardiovascular dysfunction. See also Heart disease. in patients with fat embolism, 540 Cardiovascular medications, perioperative considerations for elderly patients on, 387 388
607 Cardioversion, electrical, for atrial fibrillation in the elderly, 420 Cascades, drug, in older patients, 382 Catheter ablation, for atrial fibrillation in the elderly, 424 Catheterization, bladder, duration of, and risk of postoperative urinary retention, 476 Central nervous system dysfunction, in patients with fat embolism, 540 Cholinesterase inhibitors, perioperative considerations for elderly patients on, 387 Classification, of aortic stenosis in the elderly, 522 Clock drawing test, in assessment of postoperative cognitive dysfunction in the elderly, 491 492 Cognitive dysfunction, postoperative, in the elderly, 485 496 assessment, clock drawing test, 491 492 list-learning test, 492 Mini Mental State Examination, 491 other tests, 492 paragraph or story memory test, 492 brain imaging, 492 consequences of, 492 493 delirium, 451 464, 486 general anesthesia, surgery, and development of, 489 490 anesthetic agents, 489 490 surgical factors, 490 incidence and risk factors, 488 490 normocapnia vs. hypercapnia, 489 normotensive vs. hypotensive anesthesia, 488 489 physiology of aging, 486 487 prevention, 490 491 Competence, of geriatric patient, assessment of, 573 Complications, postoperative, in the elderly, 429 496 cognitive dysfunction, 429 450 delayed arousal, 429 450 delirium, 451 464 urinary retention, 465 484 with acute mesenteric ischemia, 601 602 Computerized tomography (CT), for delayed arousal in elderly, 441 Congestive heart failure, chronic use of beta-blockers in, 583 Consciousness, arousal pathways and effect of normal aging on delayed arousal, 430 436 aging, 435 436 cortex as site of end-effect, 434 435 nonthalamic branch of ascending arousal system, 432 433 thalamic branch of ascending arousal system, 431 432 ventrolateral preoptic nucleus, 433 434 delayed arousal in states of, 429 430 Consent. See Informed consent. Consultation, preoperative, and risk of postoperative urinary retention, 475 476 Coronary artery disease, chronic use of beta-blockers in, 584 Cortex, end-effect, in delayed arousal, 434 435 D DBS. See Deep brain stimulation. Decubitus ulcers, anatomy of, 599
608 Deep brain stimulation (DBS), for Parkinson s disease, 391 415 anesthesia for DBS lead placement, 397 404 stage 1, 397 404 stage 2, 404 for surgery in patients with implanted DBS, 404 408 treatment with, 392 396 Delayed arousal, in elderly patients, 429 450 algorithm for approaching patient with, 440 445 computerized tomography, 441 electrolytes, 444 magnetic resonance imaging, 441 metabolic abnormalities, 443 444 seizures, 442 workup, 444 445 arousal pathways and effect of normal aging, 430 436 aging, 435 436 cortex as site of end-effect, 434 435 nonthalamic branch of ascending arousal system, 432 433 thalamic branch of ascending arousal system, 431 432 ventrolateral preoptic nucleus, 433 434 in states of consciousness, 429 430 pharmacology, 436 440 Delirium, postoperative, in elderly patients, 451 464, 485 496 case presentation, 451 452 diagnosis, 453 455 epidemiology, 452 453 financial implications, 453 mechanism, 455 456 role of anesthesia, 458 460 treatment issues, 456 457 Dexmedetomidine, sedation for DBS lead placement for Parkinson s disease, 399 400 Diabetes, anesthetic care for patients with skin breakdown, 599 603 Diastolic dysfunction, cardiovascular aging, anesthesia and, 497 517 anesthetic management of for general surgery patient, 509 512 cardiac surgery patient with, 505 509 physiologic changes of aging and, 499 505 Discharge criteria, for ambulatory surgery patients, and risk of postoperative urinary retention, 477 478 Do-not-resuscitate (DNR) orders, 576 578 Doppler imaging, diastolic dysfunction, 504 508 Drug cascades, in older patients, 382 E Echocardiography, diastolic dysfunction, 499 505 for atrial fibrillation in the elderly, 423 Elderly. See Geriatric patients. Electrical cardioversion, for atrial fibrillation in the elderly, 420 Electrocautery, in Parkinson s disease patients with implanted DBS, 408 Electroencephalography, for seizures and delayed arousal in elderly and, 442 443 processed, in DBS lead placement for Parkinson s disease, 402 403
609 Electrolytes, delayed arousal in elderly, 444 Embolism, fat, in the elderly, 533 550 case presentation, 533 534 clinical presentation, 538 540 definition, 534 diagnosis, 540 542 epidemiology, 535 536 etiology, 536 537 history, 534 management, 542 544 pathophysiology, 537 538 prognosis, 544 venous air, during DBS lead placement for Parkinson s disease, 403 Epidemiology, fat embolism, 535 536 postoperative delirium in elderly patients, 452 453 Epidural analgesia, role in development of postoperative urinary retention, 473 474 Ethical issues, informed consent by older patients, 569 580 Eyes., disorders in patients with fat embolism, 540 F Fat embolism. See Embolism, fat. Financial impact, postoperative delirium in elderly patients, 453 Fluids, intravenous, resuscitation in acute mesenteric ischemia, 557 558 dynamic goal-directed, 558 559 role in development of postoperative urinary retention, 471 472 G Gender, and risk of postoperative urinary retention, 474 475 General anesthesia, and postoperative cognitive dysfunction in the elderly, 489 490 for DBS lead placement for Parkinson s disease, 400 for patient with chronic wound, 602 Geriatric patients, anesthetic considerations in, 377 603 acute mesenteric ischemia, 551 567 anesthesia, 600 601 clinical presentation, 551 552 control of blood pressure, 600 dynamic goal-directed fluid resuscitation, 558 559 dynamic measurement of systolic and pulse pressure variation, 559 fluid resuscitation, 557 558 global measures of tissue perfusion, 559 560 pathophysiology, 552 556 postoperative complications, 601 preoperative considerations, 557 traditional and static variables, 558 treatment options, 556 557 aortic valve stenosis, 519 532 anesthesia for noncardiac surgery in patients with, 527 528 classification criteria, 522 modulating therapies and strategies in, 524 526 natural progression and course of, 523 524
610 Geriatric (continued) pathophysiology, 520 522 physical examination and clinical presentation, 523 replacement, 526 527 atrial fibrillation in, 417 427 case studies, 417 418 etiology and pathophysiology, 419 incidence and prevalence, 418 419 management, 419 425 beta-blockers, perioperative use of, 581 597 common comorbidities benefiting from chronic use of, 582 584 pharmacologic effects of aging, 591 592 prophylactic use of, 584 591 recommendations, 592 cognitive dysfunction, postoperative, 485 496 assessment, 491 492 consequences of, 492 493 delirium, 486 incidence and risk factors, 488 490 physiology of aging, 486 487 prevention, 490 491 delayed arousal in, 429 450 algorithm for approaching patient with, 440 445 arousal pathways and effect of normal aging, 430 436 pharmacology, 436 440 delirium, postoperative, 451 464 case presentation, 451 452 diagnosis, 453 455 epidemiology, 452 453 financial implications, 453 mechanism, 455 456 role of anesthesia, 458 460 treatment issues, 456 457 diastolic dysfunction, 497 517 anesthetic management of for general surgery patient, 509 512 cardiac surgery patient with, 505 509 physiologic changes of aging and, 499 505 fat embolism, 533 550 case presentation, 533 534 clinical presentation, 538 540 definition, 534 diagnosis, 540 542 epidemiology, 535 536 etiology, 536 537 history, 534 management, 542 544 pathophysiology, 537 538 prognosis, 544 in patients with skin breakdown, 599 603 anatomy of decubitus ulcers, 599 601 anesthetic care of patients with chronic wounds, 601 602
611 selecting an anesthetic regimen, 602 informed consent and ethical management, 569 580 assessing competence in, 573 elements of, 571 informed refusal and do-not-resuscitate orders, 576 578 managing the incompetent patient, 574 576 promoting patient autonomy during, 573 574 special problems facing elderly, 572 573 Parkinson s disease, 391 415 for deep brain stimulator (DBS) lead placement, 397 404 for non-parkinson s disease surgery, 408 409 for surgery in patients with implanted DBS, 404 408 treatment of, 392 396 polypharmacy and perioperative medications, 377 389 adverse events related to medications, 379 380 anticholinergic activity, 381 382 Beers criteria for inappropriate prescribing, 381 drug cascades, 382 medication histories, 383 medications in older patients, 379 over-the-counter and herbal remedies, 383 perioperative considerations, 385 388 pharmacologic considerations, 384 385 urinary retention, postoperative, 465 484 demographic risk factors for, 474 475 diagnosis, 467 management of, 475 478 perioperative factors influencing development of, 467 474 physiology of micturition, 466 467 H Haloperidol, perioperative considerations for elderly patients on, 386 Heart disease, diastolic dysfunction, 497 517 anesthetic management of for general surgery patient, 509 512 cardiac surgery patient with, 505 509 physiologic changes of aging and, 499 505 Heart disease, in the elderly, aortic valve stenosis, 519 532 atrial fibrillation, 417 427 Hemodynamic monitoring, in DBS lead placement for Parkinson s disease, 402 Hemorrhage, intracerebral, during DBS lead placement for Parkinson s disease, 404 Herbal medications, in older patients, 383 Histories, medication, in older patients, 383 Hypercapnia, vs. normocapnia, and risk of postoperative cognitive dysfunction in the elderly, 489 Hypertension, chronic use of beta-blockers in, 583 584 Hypotensive anesthesia, vs. normotensive, and risk of postoperative cognitive dysfunction in the elderly, 488 489 I Imaging, brain, in assessment of postoperative cognitive dysfunction in the elderly, 492 in diagnosis of fat embolism, 541 542
612 Imaging (continued) tissue Doppler, in diastolic dysfunction, 504 508 Incompetent patients, elderly, management of, 574 576 surrogate consent for research, 576 Informed consent, by older patients, 569 580 assessing competence in, 573 elements of, 571 informed refusal and do-not-resuscitate orders, 576 578 managing the incompetent patient, 574 576 promoting patient autonomy during, 573 574 special problems facing elderly, 572 573 Informed refusal, by older patients, 576 578 Intracerebral hemorrhage, during DBS lead placement for Parkinson s disease, 404 Intravenous fluids, resuscitation in acute mesenteric ischemia, 557 558 dynamic goal-directed, 558 559 role in development of postoperative urinary retention, 471 472 L Lesioning, for treatment of Parkinson s disease, 392 Local anesthetics, limits of, for patient with chronic wound, 601 602 with sedation, for patient with chronic wound, 602 M Magnetic resonance imaging (MRI), for delayed arousal in elderly, 441-442 in Parkinson s disease patients with implanted DBS, 405, 408 MAZE procedure, for atrial fibrillation in the elderly, 422 Medications, in older patients, 379 adverse events related to, 379 380 chronic, perioperative considerations with, 385 388 drug cascades, 382 histories, 383 over-the-counter and herbal, 383 See also Polypharmacy. Memory tests, in assessment of postoperative cognitive dysfunction in the elderly, 492 Meperidine, perioperative considerations for elderly patients on, 386 387 Metabolic abnormalities, delayed arousal in elderly, 443 444 Micturition, physiology of, 466 467 Mini Mental State Examination, in assessment of postoperative cognitive dysfunction in the elderly, 491 Monoamine oxidase inhibitors, perioperative considerations for elderly patients on, 385 386 N Neuropathy, in patient with chronic wound, 601 Nonsteroidal anti-inflammatory drugs (NSAIDs), role in development of postoperative urinary retention, 474 Nonthalamic branch, of ascending arousal system, 431 432
613 Normocapnia, vs. hypocapnia, and risk of postoperative cognitive dysfunction in the elderly, 489 Normotensive anesthesia, vs. hypotensive, and risk of postoperative cognitive dysfunction in the elderly, 488 489 O Older patients. See Geriatric patients. Opioids, role in development of postoperative urinary retention, 472 473 Over-the-counter medications, in older patients, 383 P Pacing, for atrial fibrillation in the elderly, 422 423 Pain, postoperative, role in development of urinary retention, 472 Parkinson s disease, anesthetic considerations for patients with, 391 415 for deep brain stimulator (DBS) lead placement, 397 404 stage 1, 397 404 stage 2, 404 for non-parkinson s disease surgery, 408 409 for surgery in patients with implanted DBS, 404 408 treatment of, 392 396 medical, 392 surgical, 392 397 Pathophysiology, acute mesenteric ischemia, 552 556 fat embolism, 537 538 of aortic stenosis in the elderly, 530 522 Perfusion, tissue, global measure of, in acute mesenteric ischemia, 559 600 Pharmacodynamics, in elderly patients, 384 385 Pharmacokinetics, in elderly patients, 384 385 Pharmacology, considerations in elderly patients, 384 385 narrow therapeutic range, 384 pharmacokinetics and pharmacodynamics, 384 385 physiologic alterations, 384 of delayed arousal in the elderly, 436 Physiology, of aging, 486 487 Platelets, in patients with fat embolism, 540 Polypharmacy, and perioperative medications in the elderly, 377 389 adverse events related to medications, 379 380 anticholinergic activity, 381 382 Beers criteria for inappropriate prescribing, 381 drug cascades, 382 medication histories, 383 medications in older patients, 379 over-the-counter and herbal remedies, 383 perioperative considerations, 385 388 pharmacologic considerations, 384 385 Postoperative complications, in the elderly, cognitive dysfunction, 485 496 delayed arousal, 429 450 delirium, 451 464 urinary retention, 465 484 with acute mesenteric ischemia, 601 602
614 Preoperative consultation, and risk of postoperative urinary retention, 475 476 Prescribing, drug cascades in older patients, 382 inappropriate, in the elderly, Beers criteria for, 381 Prophylactic use, of beta-blockers, perioperative, in elderly patients, 584 591 contraindications, 590 591 duration of, 590 overview of studies on, 584 588 target population for, 585 timing, dosage, and choice of, 589 590 treatment effect, 589 Propofol, sedation for DBS lead placement for Parkinson s disease, 399 Psychotropic medications, perioperative considerations for elderly patients on, 385 R Regional anesthesia, for DBS lead placement for Parkinson s disease, 398 Research, surrogate consent for incompetent patients, 576 Respiratory dysfunction, in patients with fat embolism, 538 539 Retention, urinary. See Urinary retention. S Sedation, local with, for patient with chronic wound, 602 Seizures, delayed arousal in elderly and, 442 443 Serotonergic reuptake inhibitors, perioperative considerations for elderly patients on, 386 Skin breakdown, anesthetic care for patients with, 599 603 anatomy of decubitus ulcers, 599 601 in patients with chronic wounds, 601 602 selecting an anesthetic regimen, 602 Skin disorders, in patients with fat embolism, 540 Spinal anesthesia, for patient with chronic wound, 602 Splanchnic circulation, acute mesenteric ischemia in the elderly, anesthetic management of, 551 567 Stereotactic head-frame placement, for DBS for Parkinson s disease, 397 404 Surgical procedure, role in development of postoperative urinary retention, 467 469 Surgical stress, and postoperative cognitive dysfunction in the elderly, 490 Surrogate consent, for research, for incompetent patients, 576 T Thalamic branch, of ascending arousal system, 431 432 Therapeutic index, low, in elderly patients, 384 Therapeutic range, narrow, in elderly patients, 384 Tissue Doppler imaging, diastolic dysfunction, 504 508 U Ulcers, anesthetic care for patients with skin breakdown, 599 603 anatomy of decubitus ulcers, 599 601 in patients with chronic wounds, 601 602 selecting an anesthetic regimen, 602
615 Urinary retention, postoperative, 465 484 demographic risk factors for, 474 475 abnormal voiding history, 475 age and gender, 474 475 diagnosis, 467 management, 475 478 discharge criteria for ambulatory surgical patients, 477 478 duration of bladder catheterization, 476 intraoperative considerations, 475 476 pharmacologic, 477 preoperative consultation, 475 perioperative factors influencing development of, 467 474 anesthetic techniques, 469 471 epidural analgesia, 473 474 intravenous fluids, 471 472 NSAIDs, 474 opioids, 472 473 postoperative pain and analgesia, 472 surgical procedure, 467 469 physiology of micturition, 466 467 V Valve replacement, for aortic stenosis in the elderly, 526 527 Venous air embolism, during DBS lead placement for Parkinson s disease, 403 Ventrolateral preoptic nucleus, in delayed arousal, 433 434 Voiding dysfunction, postoperative urinary retention, 465 484 Voiding history, abnormal, and risk of postoperative urinary retention, 475 W Wounds, chronic, anesthetic care for patients with skin breakdown, 599 603 anatomy of decubitus ulcers, 599 601 in patients with, 601 602 selecting an anesthetic regimen, 602