Perioperative Care of the Elderly Patient

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.

Part I. Background: 1. Preoperative assessment of the elderly Sara E. Neves and Sheila Ryan Barnett; 2. Ethical issues in perioperative care of the elderly: informed consent/informed refusal Gail A. Van Norman; Part II. General Health and Illness: 3. The perioperative management of hypertension in the elderly Jeffrey B. Dobyns and Thomas R. Vetter; 4. Heart failure Rabya S. Saraf, Mario E. Montealegre and Robina Matyal; 5. Dementia Angela Georgia Catic; 6. Postoperative cognitive issues Christopher G. Hughes and Charles H. Brown, IV; 7. Renal and metabolic aging Rita S. Patel and Michael C. Lewis; 8. Frailty and functional assessment Dae Hyun Kim; Part III. Intraoperative Considerations: 9. The surgeon's perspective Cynthia E. Weber, Anthony J. Baldea and Frederick Luchette; 10. Geriatric cardiac procedures John Mitchell; 11. The aging valve Mario E. Montealegre, Rabya S. Saraf and Robina Matyal; 12. Thoracic surgery in the elderly Elifce Cosar and Stephanie Cintora; 13. Geriatric trauma: principles and anesthetic considerations Varun Rimmalapudi, Michael C. Lewis and Carol Ann B. Diachun; 14. Major surgery in the elderly James M. Hunter, Jr and Thomas R. Vetter; 15. Elective orthopedic surgery in the geriatric patient Lisa Kunze and Elizabeth Fouts-Palmer; 16. Regional and neuroaxial anesthesia in the geriatric population Shachi C. Patel; 17. Anesthesia for urologic and gynecologic surgery in the elderly Kristine E. W. Breyer; 18. Cataract surgery in the elderly George A. Dumas and Gwendolyn L. Boyd; Part IV. Postoperative Issues: 19. Critical care of the elderly patient Abirami Kumaresan and Shazad Shaefi; 20. Pain in the elderly Jason L. MeKeown and Thomas R. Vetter; 21. Palliative care Mary Buss and Ellen P. McCarthy; 22. Quality assessment and improvement in the elderly Marissa Wagner.

Sheila Ryan Barnett is Vice Chair of Perioperative Medicine, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Massachusetts, and Associate Professor, Anesthesiology, Harvard Medical School.
Sara E. Neves is an Instructor, Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Massachusetts.