UID:
almafu_9960118932002883
Umfang:
1 online resource (xiv, 267 pages) :
,
digital, PDF file(s).
ISBN:
1-108-51578-9
,
1-108-50684-4
,
1-316-44056-7
Inhalt:
Older patients carry some of the highest risks of suffering an adverse event or death following anesthesia and surgery. They are inherently vulnerable, presenting with numerous comorbidities and reduced physiological reserve, requiring 'gero-centric' perioperative care for everything from routine eye surgery to major cardiac surgeries. Dementia, frailty, and the need for palliative care and pain management for the orthopedic patient are important areas requiring special consideration in this group. This book provides a general overview of these topics for those healthcare providers who may not have extensive knowledge of this patient population, while at the same time offering practical tips for the more experienced clinician. Chapters cover the spectrum of perioperative care including preoperative management of comorbid conditions, intraoperative anesthetic management, postoperative pain control, and a primer on advanced directive discussions. This book is appropriate not only for anesthesiologists but for any perioperative physician caring for the older patient.
Anmerkung:
Title from publisher's bibliographic system (viewed on 19 Jan 2018).
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Cover -- Half Title -- Title page -- Imprints page -- Dedication -- Contents -- Contributors -- Preface -- Section 1 - Background -- 1 Preoperative Assessment of the Elderly -- Introduction -- Preoperative Assessment of Physiologic Status -- Risk Assessment Tools -- Organ System-Specific Risk Assessment -- Anesthetic History -- Medications -- Laboratory Evaluation -- Hemoglobin, Hematocrit -- Coagulation Studies -- Electrolytes and Blood Chemistry -- Electrocardiograms -- Chest Radiographs -- Type and Screen -- Special Considerations in the Elderly -- Outside Facilities -- Advanced Directives -- Fasting -- Surgical Prophylaxis -- Conclusion -- 2 Ethical Issues in Perioperative Care of the Elderly: Informed Consent/Informed Refusal -- Introduction -- Autonomy -- Competence -- The Problem of Premedication -- Voluntariness -- Disclosure -- Influence -- Coercion -- Persuasion -- Manipulation -- Informed Refusal: DNR and Other Directives Limiting Medical Care in the Setting of Anesthesia and Surgery -- Do Not Resuscitate (DNR) Orders -- Advance Directives (ADs) -- Surrogate Decision-Makers -- Conclusion -- Section 2 - General Health and Illness -- 3 The Perioperative Management of Hypertension in the Elderly -- Introduction -- Epidemiology -- Pathophysiology of Hypertension in the Elderly -- Perioperative Risks of Hypertension -- Benefits of Perioperative Hypertension Control -- Predicting Perioperative Risk -- Perioperative Blood Pressure Medication Management -- Angiotensin Converting Enzyme Inhibitors/Aldosterone Receptor Blockers -- Calcium Channel Blockers -- Diuretics -- Beta-Blockers -- Other Antihypertensives -- Optimizing Perioperative Blood Pressure Management -- Preoperative Management -- Intraoperative Management -- Treatment of Hypertension in the Postanesthesia Care Unit -- Preoperative Hypertension: Cancel or Proceed?.
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Role of the Preoperative Assessment Clinic and Perioperative Surgical Home -- Summary -- 4 Heart Failure -- Introduction -- Pathophysiology of Heart Failure -- Risk Factors -- Gender Differences -- Takotsubo Cardiomyopathy -- Diagnosis of Heart Failure -- Management of Heart Failure -- Interventional Management -- Gender Differences in Management -- Perioperative Care -- Implications of High-Risk Noncardiac Surgery -- Preoperative Evaluation -- Intraoperative and Postoperative Management -- Postoperative Management -- Conclusion -- 5 Dementia -- Introduction -- Dementia -- Diagnosis of Dementia -- Etiologies of Dementia -- Alzheimer's Disease -- Epidemiology -- Pathogenesis -- Clinical Features -- Treatment -- Vascular Dementia -- Epidemiology -- Pathogenesis -- Clinical Features -- Treatment -- Lewy Body Dementias -- Epidemiology -- Pathogenesis -- Clinical Features -- Treatment -- Frontotemporal Dementia -- Epidemiology -- Pathogenesis -- Clinical Features -- Treatment -- Postoperative Care -- Conclusion -- 6 Postoperative Cognitive Issues -- Introduction -- Postoperative Delirium -- Definition and Diagnosis -- Epidemiology -- Risk Factors and Pathophysiology -- Consequences -- Principles of Anesthetic and Perioperative Management to Reduce the Risk of Delirium -- Pain Management and Sedation -- Postoperative Cognitive Dysfunction -- Definition and Diagnosis -- Epidemiology -- Risk Factors and Pathophysiology -- Consequences -- Principles of Anesthetic and Perioperative Management to Reduce the Risk of POCD -- Summary -- 7 Renal and Metabolic Aging -- Introduction -- Pharmacokinetics and Pharmacodynamics -- Hepatic Function -- Renal Function -- Endocrine -- Conclusions -- 8 Frailty and Functional Assessment -- Epidemiology of Frailty in the Aging Population -- Frailty Assessment in Older Surgical Patients -- An Overview of Frailty Assessment.
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Frailty Assessment in the Preoperative Setting -- Surgical Risk Stratification -- Individualized Perioperative and Follow-up Care Planning -- Which Frailty Instrument Should be Used in Older Surgical Patients? -- Interventions for Frail Older Patients Undergoing Surgery -- An Overview of Interventions for Frail Older Patients -- Considerations in Anesthesia and Sedation for Surgery -- Prehabilitation and perioperative care -- Follow-up Care After Hospital Discharge -- Areas of Uncertainty -- Conclusion -- Section 3 - Intraoperative Considerations -- 9 The Surgeon's Perspective -- Introduction -- The Surgeon's Role in Preoperative Assessment of the Elderly Patient -- Elective Versus Emergent Surgery -- Laparoscopic Surgery in the Elderly -- Frailty Versus Futility -- Conclusion -- 10 Geriatric Cardiac Procedures -- Introduction -- Overall Risk of Cardiac Procedures in the Elderly -- Cardiac Risks and Outcomes by Procedure Type -- Coronary Interventions -- Stroke Rates/Neurocognitive Outcomes -- Mortality Data: RCT Versus Case Series Data and Emerging Data Trends -- Mitral Valve -- Repair Versus Replacement -- Minimally Invasive Versus Open -- MitraClip -- Transcatheter Mitral Valves -- Aortic Valve -- Primary SAVR outcomes -- TAVR Outcomes -- Redo AVR -- Mini-Sternontomy AVR -- TAVR Versus Open AVR -- Patient Selection Strategies -- Frailty and Risk Stratification -- Frailty Relationship to CAD -- Gait Speed -- Muscle Mass -- Conclusion -- 11 The Aging Valve -- Introduction -- Specific Types of Valvular Heart Disease -- Aortic Stenosis -- Aortic Regurgitation -- Mitral Stenosis -- Mitral Regurgitation -- Tricuspid Regurgitation -- Additional Factors to Consider in Patients with Valvular Heart Disease -- Anticoagulation -- Endocarditis prophylaxis -- Conclusion -- 12 Thoracic Surgery in the Elderly -- Introduction.
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The Effect of the Aging Process on Respiratory Function -- Structural Age-Related Changes -- Physiologic Age-Related Changes -- Immunologic Age-Related Pulmonary Changes -- Preoperative Pulmonary Evaluation -- Intraoperative Management -- Ventilation -- Perioperative Fluid Management -- Temperature Control -- Positioning -- The Emerging Role of Minimally Invasive Surgical Techniques -- Postoperative Management -- Postoperative Complications in Elderly Patients -- 13 Geriatric Trauma: Principles and Anesthetic Considerations -- Introduction -- Functional Reserve in the Elder -- Increased Risk for Trauma -- Prehospital Triage and Assessment -- Evaluation in the Trauma Center -- Airway -- Breathing -- Circulation -- Disability (Neurologic) -- Exposure -- Intraoperative Considerations and Resuscitation -- Postoperative Management -- Summary -- 14 Major Surgery in the Elderly -- Introduction -- Epidemiology of Major Surgery in the Elderly -- Enhanced Recovery After Surgery -- Applicability of Enhanced Recovery After Surgery to the Geriatric Patient -- Specific Elements of Enhanced Recovery After Surgery -- Prehabilitation -- Maintenance of Preoperative Homeostasis -- Goal-Directed Fluid Therapy -- Multimodal Analgesia -- Earlier Postoperative Recovery and Anesthetic Depth Monitoring -- Summary and Conclusions -- 15 Elective Orthopedic Surgery in the Geriatric Patient -- Introduction -- Joint Replacement -- Anesthetic Technique for Joint Replacement -- Multimodal Pain Management for Joint Replacement Surgery -- Regional Techniques for Pain Management -- Transfusion Practices in Total Joint Replacement -- Venous Thromboembolic Events in TJA -- Bone Cement Syndrome -- Spine Procedures -- Minimally Invasive Spine Procedures -- Summary -- 16 Regional and Neuraxial Anesthesia in the Geriatric Population -- Introduction.
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Effect of Geriatric Physiology on Regional Anesthesia -- Cardiovascular Changes -- Effect of Neuraxial Anesthesia on the Cardiovascular System -- Pulmonary Changes -- Effect of Pulmonary Changes on Regional Anesthesia -- Neurologic Changes -- Effect of Neurological Changes on Regional Anesthesia -- Effect of Age-Related Pharmacologic Changes on Regional Anesthesia -- Effect of Hepatic and Renal Changes on Regional Anesthesia -- Physiological Changes in the Musculoskeletal System in the Elderly -- Impact of Musculoskeletal Changes on Regional Anesthesia -- Risk Versus Benefit of Regional Anesthesia Versus General Anesthesia in the Geriatric Population -- Cardiovascular System -- Respiratory System -- Neurological and Cognitive Recovery Profiles -- Coagulation Systems -- Gastrointestinal System -- Conclusion -- 17 Anesthesia for Urologic and Gynecologic Surgery in the Elderly -- Introduction -- Lithotomy Positioning -- Robotic Surgery -- Transurethral Resection Syndrome -- Type of Anesthesia -- Summary -- Acknowledgments -- 18 Cataract Surgery in the Elderly -- Introduction -- Surgical Technique -- Preoperative Assessment -- Antithrombotic Therapy -- Anesthetic Techniques -- Needle Blocks -- Sub-Tenon's Block -- Topical Anesthesia -- Monitored Sedation -- General Anesthesia -- Postoperative Pain -- Benefits for the Elderly -- Section 4 - Postoperative Issues -- 19 Critical Care of the Elderly Patient -- Introduction -- A Brief History of Critical Care Medicine -- Demographics -- Where do ICU Patients Come From? -- Assessment of Health Status and Risk of Hospitalization -- ICU and Frailty -- Co-Morbidities -- Cognitive Impairment and Daily Functioning -- Admission to the ICU -- Common Diagnoses of Critically Ill Geriatric Patients -- Delirium -- Sepsis -- Trauma -- Outcomes -- Mortality of Critically Ill Elderly -- Quality of Life After ICU Admission.
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Summary.
Weitere Ausg.:
ISBN 1-107-57629-6
Sprache:
Englisch
URL:
https://doi.org/10.1017/9781316440568
Bookmarklink
