Geriatrik Hastalarda Preoperatif Değerlendirme ve Peroperatif Anestezi Yönetimi
Synopsis
Due to the increase in life expectancy, the demand for surgery and anesthesia in geriatric patients is rising, making the careful management of anatomical and physiological changes, chronic diseases, and polypharmacy imperative. To minimize perioperative and postoperative mortality and morbidity rates, a detailed history should be taken prior to surgery; during this process, the patient's nutritional, cardiovascular, respiratory, renal, and neurological conditions, past surgeries, allergies, smoking and alcohol use, as well as social support and intensive care requirements must be evaluated holistically. In physical examination, the Mallampati score and thyromental distance should be assessed to anticipate potential difficult intubation, systemic examinations should be completed, and the ASA classification system should be used for risk stratification. Before elective procedures, fasting guidelines of six to eight hours must be followed, and perioperative fluid management should be meticulously planned to prevent dehydration and renal failure. While central and peripheral blocks reduce the risk of postoperative delirium and thromboembolism, general anesthesia is preferred in patients with severe cardiovascular disease. Since the requirement for intravenous anesthetics decreases in the elderly, drugs should be administered slowly and titrated, while sevoflurane and desflurane, which provide hemodynamic stability and rapid recovery, should be selected for maintenance. Maintaining body temperature during the peroperative period, rigorously monitoring hemodynamics, and preventing blood pressure fluctuations play a critical role in preventing the development of postoperative delirium. In postoperative pain management, paracetamol stands out as the primary and reliable option, whereas opioid medications, which carry a high risk of respiratory depression, must be administered with extreme caution.
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