老年病人的麻醉管理.ppt

AnestheticManagementoftheElderlyPatientRaymondC.Roy,PhD,MDProfessorChairofAnesthesiologyWakeForestUniversityHealthSciencesWinston-Salem,NC,USA27157-1009Education:AnnualMeeting–AmericanSocietyofAnesthesiologists

Hayflick’sViewofAging“Becausemodernhumans,unlikeferalanimals,havelearnedhowtoescapedeathlongafterreproductivesuccess,wehaverevealedaprocessthat,teleologically,wasneverintendedforustoexperience.”

#OlderAmericans 2000 203065yrs 12.4% 19.6% 35mil 71mil80yrs 9.3mil 19.5mil

TheOldest…..MAN 120yrsWOMAN 122GuinnessBookofRecordsGENERALANESTHETIC 113BrJAnaesth2000;84:260

LifeExpectancyatbirthUSA-1997WOMEN Caucasian 79.9yrs African-American 74.7MEN Caucasian 74.3 African-American 67.2

LifeExpectancy,LifeSpan,MaximumLengthofLifeMaximumLengthofLife 120yrsLifeSpan 85-100Naturaldeath(notraumaordisease)LifeExpectancy(USA) 67-80Prematuredeath(trauma,disease)

OldestSurgicalPatient?

Oliver.BrJAnaesth2000;84:260Woman,113yrs,femoralfractureGeneralanesthesiaCVP,noarterial-lineExtubationinICUafter5hHospitaldischargePOD23

#Anestheticsper100Population?

Clergue.Anesthesiology1999;91:1509(France)Ages(yrs)MenWomen35–448.913.255-6417.714.675-8430.223.6

VascularSurgery–MortalityvsAge

Fleisher.AnesthAnalg1999;89:849

PerioperativeComplicationRatesinMedicarePatientsIntermediateRiskSurgery-42%Silber,Anesthesiology2000;93:152217,440generalorthopedicsurgeryLowRiskSurgery-3%Schein,NEnglJMed2000;342:16818,901cataractsurgery

AgePerioperativeOutcomeWithadvancingageMoresurgeryMorbidityincreasesMortalityincreasesCause-diseasevsage?Diseaseagewhen85yrsAgemay=diseasewhen85yrsIncreaseASAPSwhen85yrs

PreoperativeConsiderationsPreoperativeAssessmentNoroutinepreoperativetestingStatinmyopathi