Table Of Content

Perioperative Care of the Elderly Patient 06:00:56, subject to the Cambridge 06:00:56, subject to the Cambridge Perioperative Care of the Elderly Patient Edited by Sheila Ryan Barnett Vice-Chair of Perioperative Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Associate Professor of Anesthesia, Harvard Medical School, Boston, MA, USA Sara E. Neves Instructor of Anesthesia, Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA 06:00:56, subject to the Cambridge University Printing House, Cambridge CB2 8BS, United Kingdom Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. www.cambridge.org Information on this title: www.cambridge.org/9781107576292 © Cambridge University Press 2018 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2018 Printed in the United Kingdom by Clays, St Ives plc A catalogue record for this publication is available from the British Library. Library of Congress Cataloging-in-Publication Data Names: Barnett, Sheila Ryan, editor. | Neves, Sara E., editor. Title: Perioperative care of the elderly patient / edited by Sheila Ryan Barnett, Sara E. Neves. Description: Cambridge, United Kingdom ; New York : Cambridge University Press, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2017035930 | ISBN 9781107576292 (pbk.) Subjects: | MESH: Perioperative Care | Aged Classification: LCC RD49 | NLM WO 950 | DDC 617.9/192—dc23 LC record available at https://lccn.loc.gov/2017035930 ISBN 978-1-107-57629-2 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. 06:00:56, subject to the Cambridge I would specifically like to thank my co-editor Sara Neves, an anesthesiology intensivist, who represents the next generation of perioperative champions. I look forward to continued collaborations over shared elderly patients and new “gero-centric” endeavors. I would also like to thank my colleagues, many of whom co-authored chapters, for their interest and support of all things “geriatric” in our emerging perioperative world. Finally, to my family: John, Elizabeth and Gannon – thank you for your patience and enthusiasm for my work endeavors and the humor and love you bring into my life. Sheila Ryan Barnett I would like to dedicate this book to my parents, whose love and support have guided me throughout my life. I also want to thank my husband and two daughters for their love and patience in allowing me to contribute to this important work. Sara E. Neves 06:06:24, subject to the Cambridge 06:06:24, subject to the Cambridge Contents Contributors ix Preface xiii Section 1 – Background Section 3 – Intraoperative Considerations 1 Preoperative Assessment of the Elderly 1 9 The Surgeon’s Perspective 99 Sara E. Neves and Sheila Ryan Barnett Cynthia E. Weber, Anthony J. Baldea 2 Ethical Issues in Perioperative Care and Fred A. Luchette of the Elderly: Informed Consent/ 10 Geriatric Cardiac Procedures 108 Informed Refusal 14 John D. Mitchell Gail A. Van Norman 11 The Aging Valve 119 Mario E. Montealegre, Rabya S. Saraf Section 2 – General Health and and Robina Matyal Illness 12 Thoracic Surgery in the 3 The Perioperative Management of Elderly 134 Hypertension in the Elderly 25 Elifce Cosar and Stephanie Cintora Jeffrey B. Dobyns and Thomas R. 13 Geriatric Trauma: Principles and Vetter Anesthetic Considerations 149 4 Heart Failure 38 Varun Rimmalapudi, Michael C. Lewis and Carol Ann B. Diachun Rabya S. Saraf, Mario E. Montealegre and Robina Matyal 14 Major Surgery in the Elderly 158 5 Dementia 47 James M. Hunter, Jr. and Thomas R. Vetter Angela Georgia Catic 15 Elective Orthopedic Surgery in the 6 Postoperative Cognitive Issues 59 Geriatric Patient 173 Christopher G. Hughes and Charles H. Lisa Kunze and Elizabeth Brown IV Fouts-Palmer 7 Renal and Metabolic Aging 75 16 Regional and Neuraxial Anesthesia Rita S. Patel and Michael C. Lewis in the Geriatric Population 185 8 Frailty and Functional Shachi C. Patel and Anasuya Assessment 83 Vasudevan Dae Hyun Kim vii 06:08:51, subject to the Cambridge viii Contents 17 Anesthesia for Urologic and 20 Pain in the Elderly 223 Gynecologic Surgery in the Jason L. McKeown and Thomas R. Elderly 193 Vetter Kristine E. W. Breyer 21 Palliative Care 234 18 Cataract Surgery in the Mary K. Buss Elderly 201 22 Quality Assessment and George A. Dumas and Improvement in the Elderly 246 Gwendolyn L. Boyd Marissa Wagner Mery Section 4 – Postoperative Issues Index 259 19 Critical Care of the Elderly Patient 211 Abirami Kumaresan and Shahzad Shaefi 06:08:51, subject to the Cambridge Contributors Anthony J. Baldea MD Stephanie Cintora MD Assistant Professor, Trauma, Surgical Assistant Professor, Department of Critical Care and Burns, Loyola University Anesthesiology, University of Massachusetts Medical Center, Maywood, IL, USA Medical School, UMass Memorial Medical Center, Worcester, MA, USA Sheila Ryan Barnett MD Associate Professor, Harvard Medical Elifce Cosar MD School, Department of Anesthesiology, Clinical Vice-Chair, University of Critical Care and Pain Medicine, Vice Massachusetts Medical School, Chair for Perioperative Medicine, Beth UMass Memorial Medical Center, Israel Deaconess Medical Center, Boston, Worcester, MA, USA MA, USA Carol Ann B. Diachun MD MSEd Gwendolyn L. Boyd MD Professor, Department of Anesthesiology, Chief, Department of Anesthesiology, University of Florida, Jacksonville, FL, USA UAB Callahan Eye Foundation Hospital, Jeffrey B. Dobyns DO Birmingham, AL, USA Associate Professor, Department of Kristine E. W. Breyer MD Anesthesiology and Perioperative Assistant Professor, Department of Medicine, University of Alabama School Anesthesia, UCSF School of Medicine, of Medicine, Birmingham, AL, USA San Francisco, CA, USA George A. Dumas MD Charles H. Brown IV MD MS Assistant Professor, Department of Assistant Professor, Division of Anesthesiology and Perioperative Cardiac Anesthesia, Department of Medicine, University of Alabama School Anesthesiology and Critical Care of Medicine, Birmingham, AL, USA Medicine, Johns Hopkins University, Elizabeth Fouts-Palmer MD Baltimore, MD, USA Instructor in Anesthesiology, Weill Mary K. Buss MD MPH Cornell Medical College, Cornell Assistant Professor, Harvard Medical University, New York, NY, USA School, Director, Ambulatory Palliative Christopher G. Hughes MD Care, Beth Israel Deaconess Medical Associate Professor, Division of Critical Center, Boston, MA, USA Care, Department of Anesthesiology, Angela Georgia Catic MD Vanderbilt University School of Medicine, Assistant Professor, Director Geriatric Nashville, TN, USA Medicine Fellowship, Baylor College of Medicine, Medical Director, Geriatric PA Residency Program, Michael E. DeBakey VA Medical Center, Houston, TX, USA ix 06:14:14, subject to the Cambridge