Perioperative Elderly Management

Being told that something is wrong with you can be scary. Getting surgery performed on you can be terrifying. Patients that must be undergo anesthesia could become apprehensive about the whole procedure. But what helps is knowing that there is an anesthetist with you along the way. The anesthetist informs the patient of the surgery and attempts to calm their nerves before surgery. The anesthetist monitors and ensures the patient is stable during the surgery and informs the patient of the result of the surgery after the surgery. Essentially, the sole person that is concerned about the body as a whole during the surgery is the anesthetist. Two years ago, I had no idea what an anesthesiologist assistant was or that this highly skilled profession

Anesthesiologists give patients anesthetics in a variety of ways, such as “orally, intravenously, by gas or direct injection to render patients insensible to pain Anesthesiologists typically maintain the same daily schedule a surgeon follows, participating in both scheduled and unscheduled operations. Anesthesiologists are responsible for determining the proper anesthetic and dosage level for each patient. They monitor the patients progress prior to, during, and after surgery.”(“Anesthesiologist” 31)

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

Over one-third of the surgeries in the United States are performed on patients aged 65 and older, and delirium is one of the most common postoperative complications in this population. Despite the high incidence of delirium, the syndrome often goes undiagnosed. Postoperative delirium is associated with adverse functional and cognitive outcomes, increased hospital length of stay, cost of care, and mortality rate. Knowledge of the risk factors that predict postoperative delirium will aid early identification of the patients at highest risk in order to facilitate preoperative optimization by managing comorbidities or employing targeted prevention strategies.

The investigation of how anesthesia effects cognitive functioning has had a long history. Overtime, it has been suggested that there is an association between anesthesia, surgery, delirium, dementia and postoperative cognitive dysfunction (Inan & Ozkose Satirlar, 2015). The theory of anesthesia’s impact on cognitive functioning was derived in 1887, by Savage, who began to observe the “insanity” that follows the use of anesthesia. He suggested that “Any cause which will give rise to delirium may set up a more chronic form of mental disorder quite apart from any febrile disturbance” (Savage, 1887, p. 1199). Delirium can be defined as an altered level of consciousness that may cause a sudden decline in attention and focus perception (Isik, 2015). Postoperative delirium was reevaluated in 1955 when Bedford used a series of case studies collected over a 50 year span to describe a connection between anesthesia and dementia. The results suggest that 10% of the patients had postoperative cognitive dysfunction (Bedford, 1955). Since these initial studies, research has persisted using a variety of methods, in an attempt to determine: both long- and short-term effects of anesthesia on cognitive functioning and memory; whether the anesthesia administration technique will change the outcome of postoperative cognitive dysfunction; and other risk factors that may be associated to AD.

99100 anesthesia for a patient of extreme age; younger than 1 year or older than 70

• Since 1991, anesthetic and surgical techniques have improved, resulting in lower surgical risk for many patients. Concurrent with these changes, the VHA has implemented a rigorous program of surgical attending oversight of the process of care by resident operators, particularly in surgical suites.

The relationship between the perioperative nurse and the patient has suffered a long process of mutation throughout the last decades. If before all the dynamics experienced within an operating theatre were based upon organizational and logistical aspects, these days the focus lies on the patient and all the comfort and security demanded throughout a process that already reveals itself aggressive for the patient. Being the front-line person in this dynamic, the anaesthetic nurse plays a crucial and intense role on the patient’s experience.

Could you imagine going through a surgery without anesthetics? You know, an anesthesiologist isn't the only one who gives anesthesia—it's a team effort. Nurse anesthetists have been the primary administers of anesthesia since World War II. Many health care facilities do not have anesthesiologists on staff, but they have a CRNA, or a Certified Registered Nursing Anesthetist. They are the nurses that put IVs (intravenous sedatives) into patients before surgery, as well as a combination of other medicines to relax the patient ("Nurse Anesthetist" Career Articles). The anesthesia promotes a controlled state of unconsciousness, muscular relaxation, and insensitivity to pain. So when you go to the operating room, you will most likely have a nurse

The role of the anesthesiologist is to relieve pain for the patient during and after surgery. The Bureau of Labor Statistics defines the role of an anesthesiologist as: “…they administer the drugs that eliminate the sensation of pain…During surgery, they are responsible for adjusting the amount of anesthetic as needed and monitoring the patient’s heart rate, body temperature, blood pressure, and breathing.”1 Anesthesiologists, because they are in the midstream of perioperative care and thus can contribute to better patient outcomes and patient safety.2 On top of that, anesthesiologists are also responsible for the patients’ preoperative assessment and postoperative assessment.3

The values such as communication, innovation, quality, and collaboration is key to the growing field of perioperative nursing (AORN, 2015). During surgery communication is important between surgeons, anesthesia and nursing. Surgeons are focused on surgery, anesthesia takes care of breathing and vital signs, nurses are at the bedside or circulating and can assess the OR and what is happening during the procedure. The ARON believes that every patient has the right to receive the highest quality of perioperative nursing care of every surgical or invasive setting; all health care providers must collaborate and strive to create an environment of patient safety; and every patient experiencing a surgical or invasive

Anesthesia was developed in order to block or prevent pain during medical procedures. Anesthesia has been the backbone of the medical world for around 100 years now. Early anesthetics were primitive and many patients simply did not trust anesthetics. Anesthesia is still a risky process even in todays advanced medical world. Anesthesia is not used to treat or diagnose any specific disease; the sole purpose is to aid both the patient and surgeon through procedures. However, anesthesia is used in different ways based on the magnitude of the procedure. There are three levels of anesthesia which include; local, regional, and general anesthesia. An anesthesiologist determines which type of anesthesia will be needed.

Life as an Anesthesiologist Becoming an anesthesiologist is fulfilling with many benefits. Anesthesiology is a medical specialty that focuses on perioperative medicine and the administration of anesthesia. An anesthesiologist is a specialist who plans, performs, and maintains a patient’s anesthesia during a surgical or medical procedure. Some of an anesthesiologist's responsibilities for a patient undergoing surgery start at the point of making a pre-anesthetic evaluation and creating an anesthesia plan for the operation. Being an anesthesiologist is a successful job.

Ripping, piercing, probing, prodding, slicing, poking, cutting, carving...and you won't feel a thing, thanks to the miracle of anesthesiologists. An Anesthesiologist has lot of different responsibilities, but an anesthesiologist is not just a direct job . There are different surgeries that they handle and not every surgery requires the same anesthetics. Considering the different types of anesthetics there are multitudinous of anesthesiologists. It is expected that the patients really get fidgety when it comes to surgery, vaguely they ask questions mostly to ease them before the surgery. Nevertheless, others think that an anesthesiologist isnt important in the medical field, for the reason that the surgeon does “most of the work”. However,

The purpose of this paper is to analyze if there is any improvement, post-operative complications, mortality and related factors of elderly undergoing cardiac surgery. The debate whether or not we are pushing the limits is still questionable because of the complications associated with these invasive surgeries and whether or not if it’s a money game. The growing numbers of the elderly patients enjoy a prescription drug benefit, access to artificial knee and hip surgery, and life-saving cardiovascular interventions that were undreamed of a half-century ago.