Geriatrik Anestezi
Synopsis
The growing geriatric population resulting from improved living conditions brings an increased need for surgical and anesthetic interventions. During the aging process, organ reserves and anabolic processes decline while catabolic processes increase. In the cardiovascular system, increased collagen and tissue stiffness reduce diastolic filling, while elevated systemic vascular resistance paves the way for hypertension, left ventricular hypertrophy, arrhythmias, and heart failure. Additionally, a weakened beta-receptor response limits cardiac output response to physiological stimuli such as exercise. In the respiratory system, reductions in chest wall compliance, muscle strength, mucociliary activity, and cough reflex elevate the risk of postoperative pulmonary complications and infections. In the central nervous system, neuronal loss and decreased cerebral blood flow increase sensitivity to anesthetic agents, triggering the risk of postoperative delirium and cognitive dysfunction. Therefore, patients must be thoroughly evaluated preoperatively using a multidisciplinary approach regarding physical risks, comorbidities, medication use, and cognitive status. In perioperative management, there is no single optimal method, so the anesthetic technique should be customized individually, with reduced doses of propofol, remifentanil, and desfluran. Muscle relaxants such as atracurium or cisatracurium, which depend less on renal and hepatic elimination, should be preferred, alongside neuromuscular monitoring. Active warming measures must be taken to prevent hypothermia, fluid therapy should be goal-directed, and pain management should prioritize paracetamol and regional techniques. Comprehensive evaluation and holistic perioperative care significantly reduce postoperative morbidity and mortality in geriatric patients.
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