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The Society for the Advancement of Geriatric Anesthesia (SAGA) is dedicated to improving the care of the older patient coming to surgery. It offers educational programs at its annual meeting as well as at meetings of other anesthesia societies. It also offer educational support for anesthesia training programs. [7]
Anticholinergics can be used as a long-acting patch placed behind the patient's ear. Adverse effects include dry mouth and blurry vision. Care must be taken when handling the patch, as transfer of medication to the eye can induce pupillary dilation. Avoid use in elderly patients. Medications include scopolamine.
TIVA is used to induce general anesthesia while avoiding the disadvantages of volatile anesthesia (and traditional inhalation agents). [9] Intravenous anesthetic agents are titrated at safe doses to maintain stage III surgical anesthesia (unconsciousness, amnesia, immobility, and absence of response to noxious stimulation). [10]
Its causes are under investigation and occurs commonly in older patients and those with pre-existing cognitive impairment. [2] The causes of POCD are not understood. It does not appear to be caused by lack of oxygen or impaired blood flow to the brain [3] and is equally likely under regional and general anesthesia.
In a practical sense, these medical tapes/dressings may be difficult to remove from a patient because their ends can become stuck flush with the skin. The possibility of tape removal causing trauma is also significantly increased in older people, people with sensitive skin, dermatitis, dehydration or side effects of medications. [14]
General anesthesia is usually considered safe; however, there are reported cases of patients with distortion of taste and/or smell due to local anesthetics, stroke, nerve damage, or as a side effect of general anesthesia. [46] [47] At the end of surgery, administration of anaesthetic agents is discontinued.
Effects are seen within 2–5 minutes, and last 30–60 minutes. [7] [3] Its main effect is anxiolysis, helping to reduce feelings of anxiety, and amnestic effects, helping the patient to forget memories associated with the procedure. It provides no analgesia, so it was commonly used with fentanyl for effective PSA prior to propofol and etomidate.
Patients under general anesthesia are at greater risk of developing hypothermia, as the aforementioned vasodilation increases the heat lost via peripheral blood flow. By and large, these drugs reduce the internal body temperature threshold at which autonomic thermoregulatory mechanisms are triggered in response to cold.