Seminars in Cardiothoracic and Vascular Anesthesia

 

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This version was published on March 1, 2008
Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 12, No. 1, 18-28 (2008)
DOI: 10.1177/1089253208316446

Cardiac Anesthesia and Surgery in Geriatric Patients

George Silvay, MD, PhD

Department of Anesthesiology, Mount Sinai Medical Center, george.silvay@msnyuhealth .org

Javier G. Castillo, MD

Department of Cardiothoracic Surgery Mount Sinai Medical Center, New York

Joanna Chikwe, FRCS-CTh

Department of Cardiothoracic Surgery Mount Sinai Medical Center, New York

Brigid Flynn, MD

Department of Anesthesiology, Mount Sinai Medical Center

Farzan Filsoufi, MD

Department of Cardiothoracic Surgery Mount Sinai Medical Center, New York, farzan.filsoufi@ mountsinai.org

The average age of US population is steadily increasing, with more than 15 million people aged 80 and older. Coronary artery disease and degenerative cardiovascular diseases are particularly prevalent in this population. Consequently, an increasing number of elderly patients are referred for surgical intervention. Advanced age is associated with decreased physiologic reserve and significant comorbidity. Thorough preoperative assessment, identification of the risk factors for perioperative morbidity and mortality, and optimal preparation are critical in these patients. Age-related changes in comorbidities and altered pharmacokinetics and pharmacodynamics impacts anesthetic management, perioperative monitoring, postoperative care, and outcome. This article updates the age-related changes in organ subsystems relevant to cardiac anesthesia, perioperative issues, and intraoperative management. Early and late operative outcome in octogenarians undergoing cardiac surgery are reviewed. The data clearly indicate that no patient group is "too old" for cardiac surgery and that excellent outcomes can be achieved in selected group of elderly patients.

Key Words: cardiac anesthesia • cardiac surgery • geriatric patients • operative outcome


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