introduction

Anesthesia is a burden on the body at any age. In older people, however, special things must be considered when planning anesthesia. On the one hand, older people also have more side effects that need to be integrated into anesthesia planning. Just like any medication they take. Furthermore, older people are at increased risk of having temporary confusion after surgery. In technical language this is called a postoperative delirium.

Which special features exist?

In the elderly, anesthesia can pose quite different risks than in younger people. Therefore, it should be considered before each operation whether the benefits of the operation outweigh the risks, or whether there are also gentler procedures that may eventually lead to the same result. Older people also often have a number of side-diseases, which must be treated with medication.

Therefore, it is important in the context of anesthesia planning to look for which medications need to be discontinued, exchanged or added before surgery. Furthermore, before the anesthesia, the heart and lung function ( see also : Disease of the heart) must be examined to ensure that the body can withstand the stress of surgery and the ventilation is ensured.

What risks exist?

The fact that hardly any elderly person is completely healthy, the side diseases can be problematic for anesthesia. Especially diseases of the cardiovascular system or diabetes should be mentioned. People with these disorders have more frequent complications during anesthesia. Another risk arises from the fact that the anesthesia important protective reflexes are lifted.

It may then happen that stomach contents rise and be inhaled. If the stomach contents in the lungs, this can lead to pneumonia. Therefore, it is just so important to be sober before anesthesia to minimize this risk. Should the dental status of older people be in need of renovation, there is a risk that the teeth may be injured when the breathing bag is inserted. This rarely happens, but the risk of bad teeth is increased.

What can be after-effects after anesthesia in the elderly?

An after-effect, which is more common in the elderly, is a temporary confusion or disorientation after surgery. In addition, an older body needs a little more time to recover from the anesthesia, so it can lead to a temporary weakness. However, it is very important to be mobilized as soon as possible after anesthesia and surgery to avoid complications of bed-rest.

In addition, the classic after effects of anesthesia, such as nausea and vomiting may also occur in older people. Especially women are affected by this aftereffect. Hoarseness and light pain around the neck can occur even a few days after anesthesia due to the breathing tube. Also possible is a feeling of cold and muscle tremors after surgery. However, this aftertaste settles quickly.

confusion

The risk of postoperative confusion increases with age. Other negative factors are side-effects, such as diabetes, cardiovascular disease or depression. In addition, patients taking drugs for depression or tranquilizers (benzodiazepines) have a comparatively higher risk of suffering from such confusion.

Especially the secondary diseases 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 the anesthesia, it should be counteracted with drugs and other measures as soon as possible, since a long confusion has a bad effect on the prognosis.

What can be done to reduce after-effects?

The anesthetist can control the depth of anesthesia during surgery, medication, or anesthetic gas. For risk factors that foster confusion, the anesthetist would try to keep the anesthesia as flat as possible. This is a degree walk, as the anesthesia must not be too shallow at the same time so that the patient does not notice the operation.

If there is any confusion after the anesthesia, relatives can be of great help. Their mere presence gives the patient a familiar and secure feeling. Relatives are encouraged to explain to the patient where he is and what has happened. Tools, such as watches or glasses, can help the patient to find their way around his unknown environment.

Frequently, the day-night rhythm is confused in these patients. It helps, therefore, by measures, such as reading aloud, to assist the patient in the evening falling asleep. In justified cases, one can still give low-dose drugs against the confusion. In general, after surgery, rapid mobilization against many aftereffects of anesthesia and surgery may help.


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