老年病人手术的麻醉.ppt

AGE-RELATED ANATOMIC PHYSIOLOGICAL CHANGES CARDIOVASCULAR SYSTEM RESPIRATORY SYSTEM METABOLIC ENDOCRINE FUNCTION RENAL FUNCTION GASTROINTESTINAL FUNCTION NERVOUS SYSTEM MUSCULOSKELETAL CARDIOVASCULAR SYSTEM 1 atherosclerosis reduction in arterial elasticity Reduced arterial compliance Baroreceptor function is depressed Increased vagal tone and decreased sensitivity of adrenergic receptors lead to a decline in heart rate CARDIOVASCULAR SYSTEM 2 loss of sinoatrial node cells increase the incidence of dysrhythmias, particularly atrial fibrillation and flutter CARDIOVASCULAR SYSTEM 3 Doppler echocardiography diastolic dysfunction may be seen with systemic hypertension, coronary artery disease, cardiomyopathies, and valvular heart disease, particularly aortic stenosis CARDIOVASCULAR SYSTEM 4 Diastolic dysfunction results in increases in ventricular end-diastolic pressure with small changes of left ventricular volume Atrial enlargement atrial fibrillation and flutter developing congestive heart failure CARDIOVASCULAR SYSTEM 5 Diminished cardiac reserve induction of general anesthesia A prolonged circulation time delays the onset of intravenous drugs but speeds induction with inhalational agents elderly patients have less ability to respond to hypovolemia, hypotension, or hypoxia with an increase in heart rate RESPIRATORY SYSTEM 1 Elasticity is decreased in lung tissue Both anatomic and physiological dead space increase Mask ventilation may be more difficult in edentulous patients, whereas arthritis of the temporomandibular joint or cervical spine may make intubation challenging. On the other hand, the absence of upper teeth often improves visualization of the vocal cords during laryngoscopy RESPIRATORY SYSTEM 2 Prevention of perioperative hypoxia,a higher inspired oxygen concentrations during anesthesia Aspiration pneumonia is a common and potentially life-threatening complication in elderly patients pain control techniques that facilitate postoper