Transcript Anesthesia, Special Populations

Anesthesia Consideration
for Special Populatons
Pregnant
Geriatric
Diabetic
Obese
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The presence of fetus and placenta
Aorta and vena caval compression
Reflux and possible aspiration of gastric
contents
Decreased gastric motility and emptying
Diaphragm displaced 4 cm by fundus
Intubation difficulties
Increased oxygen consumption
Increased blood volume
The Pregnant Patient-Physiologic
Changes
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Remember you are treating 2 patients
Have fetal monitor on during surgery
Treat pt as if they have a full stomach
Epidural/spinal anesthetic preferred
Prevent decreased blood flow to fetus by
placing pt in left side down tilt
In general anesthesia, position, prep and
drape pt, then induce, cricoid pressure
ALWAYS!
Monitor urine output and temperature
Anesthetic Considerations
Elective:
 Cervical Cerclage
 Cholecystectomy
 C-section
Emergent:
*Trauma
*C-section
Common Surgical Procedures
Decreased subcutaneous fat
Decreased muscle strength and amount
Decreased chest capacity, decreased respiratory
muscle strength
 Decreased cardiac output, stroke volume,
 Increased vascular resistance, dilation of veins
 Decreased saliva production, delayed emptying
of stomach
 Slowed release of insulin from pancreas
 Slowed metabolism of drugs in liver
 Fluid/electrolyte imbalances
 Decreased renal function
 Impaired vision and hearing
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The Geriatric Patient-Physiologic
Changes
Pre-op:
Check lab work, EKG, thorough H&P
Intra-op: (Due to physiologic changes)
*need for lower doses of medications
*induction/ventilation prolonged d/t decreased
lung capacity or disease
*avoid rapid decrease in BP
*careful positioning and padding
Post-op:
*watch for drug interactions
*aspiration
Anesthetic Considerations
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Blood glucose level fluctuates/unpredictable
Wounds slow to heal
Increased heart rate
Predisposed to coronary artery disease
Peripheral edema/decreased peripheral
perfusion
Predisposed to infection
Electrolyte imbalance
Motor/sensory deficit
Small vessels affected in kidneys/eyes leads
to decreased function and damage
The Diabetic Patient-Physiologic
Considerations
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Should be scheduled as 1st case or as early
as possible
Check glucose level prior to and during
surgery
Pre-op insulin dose may be needed for Type l
Maintain adequate hydration
Avoid NG tube
Use of SCD(Sequencial Compression Device)
leggings
Careful skin preparation and
padding/protecting of extremities, etc.
Use hypoallergenic tape on skin (securing ET
tube)
Anesthetic Considerations
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Obesity=greater than 100 lb over ideal body
weight
Morbid=greater than 110%to 120% of IBW
Increased demand on the heart leads to
myocardial hypertrophy
Hypertension
Poor venous return
Hypoxemia, respiratory compromise
Gallbladder disease
Diabetes
Osteoarthritis
Excess adipose tissue
The Obese Patient-Physiologic
Changes
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Potential for difficult intubation
Potential for difficulty ventilating
Slower uptake of anesthetic gas,
prolonging induction
High adipose tissue concentration requires
higher doses of medication
Recovery from effects of medications
given during surgery is prolonged (longer
wake-up)
Anesthetic Considerations
Berry & Kohn's Operating Room
Technique.12th edition, by N. Phillips
*http://www.whathealth.com/bmi/formula.
html
References