True or False:  (yay)

1) ASA classification is linked to predictive post operative outcomes.

2) Emergent surgery carries a higher risk comparitively to Elective Surgery

3) Pulmonary complications with surgery increase based on duration of surgery, obesity and ages > 60

4) Males have a higher mortality rate than females over age 65.

1) True

2) True

3) False- Ages greater than 70

4) False- femialse have a higher mortality rate

Rate the following as Poor, Moderate, or Excellent:

I can do activity:

1) > 7 METS

2) 4-7 METS

3) <4 METS

1) Excellent

2) Meoderate

3) Poor

What are some questions we could as our patients regarding level of activity as it relates to METS?

(Use when determining risk preoperatively)

Specifically 1- 4 METS?

1) Eat, dress, use the toilet

2) Walk indoors around house

3) Walk 1-2 blocks on level ground

4) Light house work

How many METS would you assign the following activities of daily living?

1) Climb fight of stairs, walk up a hill

2) Walk briskly on level ground

3) run a short distance

4) Do heavy house work

5) Golf, Bowling, dancing, doubles tennis

I dunno specifically-

But Gayle's slides have: 4-------> 10 METS listed for all.

Value of Preoperative testing before low risk surgery:

When should tests be ordered???

It was found in a humungous study of cataract pts that complication rates were similar in those with tests vs. those without.  Therefore not especially useful. 

Therefoore:

"Tests should be ordered only when the history or finding on a physical examination would have indicated the need for the test even if surgery had not been planned"

Hardest routine preoperative tests to justify are?

(there are 3 per Gayle)

1) Chest x-ray

2) PT/PTT (if no heparin or warfarin)

3) Liver Function tests

In the elderly:  reduction in arterial elasticity does what to the following?

1) Afterload

2) systolic BP

3) LV Wall thickness

4) LV cavity size

1) increases

2) Increases

3) Increases

4) Decreases

In terms of Cardiosvascular changes with the elderly-

This dysfunction is very common in the elderly and due to an increase in LVEDP.  Symptoms include: exercise intolerance, dyspnea, cough or fatigue. 

This same dysfunction may be seen with systemic HTN, CAD, Cardiomyopathy, and valvular Heart disease (especially aortic stenosis) 

You might detect it by doppler echocariography. 

What dysfunction am I talking about?

Hemorrhoids!!

(Nah just kidding)

Diastolic Dysfunction. 

In the elderly there may be atrial enlargement.

1) What can this lead to? 

2) This could also cause an increased risk for what condition?

1) A-Fib/ A-flutter

2) CHF

In the Elderly- 

1) Why would I see a decline in heart rate of 1 beat a minute per year after the age of 50? 

2) What happens to demand response in the elderly?

1) Because there is an increase in vagal tone and a decrease in sensitivity of adrenergic receptors. 

2) Response to demand is reduced.

Regarding Anesthetic Management of the elderly TRUE OR FALSE:

1) Diminished cardiac reserve may manifest as as slight drops in BP during induction. 

2) Prolonged circulation time speeds IV Anesthetic drugs BUT delays induction with inhalation anesthetics. 

3) Elderly have less ability to respond to hypovolemia, hypotension, or hypoxia with an increased heart rate.

1) False.  Exaggerated.  Also it is harder to bring their BP back up when it does drop. 

2) False.  Delays IV drugs BUT speeds induction w/ inhalation agents.

3) True

Changes in Respiratory System in Elderly:

Answer Increased or Decreased to the following:

1) Elasticity in lung tissue

2) Alveolar surface Area

3) PaO2

4) Residual Volume

5) Closing Capacity

6) VQ mismatching/ Hypoxemia

7) Chest Wall rigidity

8) Muscle strength

9) Response to hypercapnia and hypoxia

1) Decreased

2) Decreased

3) Decreased

4) Increased

5) increased

6) increased

7)increased

8) decreased

9) Decreased (or blunted- If you will)

Age vs Oxygen Tension (PaO2) :

For Adults and Children:

1) What is normal?

2) What is an acceptable range?

3) What is considered hypoxemia

For the newborn:

4) What is an acceptable range?

For the aged:  What are the accptable ranges for:

5) Age 60?

6) Age 70?

7) Age 80?

8) Age 90?

9) Age 100?

1) 97 mmHg

2) >80 mmHg

3) <80 mmHg

4) 40-70 mmHg

5) >80 mmHg

6) >70 mmHg

7) >60 mmHg

8) >50 mmHg

9) You get to have whatever PaO2 you want.  You earned it.

What do we include in our care of the elderly in order to prevent perioperative hypoxia?

1) Longer pre-oxygenation

2) Higher FIO2

3) Small increments of PEEP

4) Agressive pulmonary toileting

Fill in the blanks: Regarding elderly resp. status.

There is a progressive ______1_______ in protective airway reflexes with age which equals a ____2______ aspiration risk

1) decrease

2) increased