PREOPERATIVE AND PERIOPERATIVE ISSUES IN THE ELDERLY Sarah M. McGee, MD , MPH Director of Education Division of Geriatrics November 7, 2008 August 5, 2009. AGS. THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving care for older adults.
PREOPERATIVE AND PERIOPERATIVE ISSUES IN THE ELDERLYSarah M. McGee, MD, MPHDirector of Education Division of GeriatricsNovember 7, 2008August 5, 2009
THE AMERICAN GERIATRICS SOCIETY
Geriatrics Health Professionals.
Leading change. Improving care for older adults.
CASE (1 of 3)
Each risk factor is assigned 1 point
Risk of CV event (MI, pulm edema, v-fib, cardiac arrest)
Will results of test change management?
Clear guidelines from 7th Conference on Antithrombotic and Thrombolytic Therapy, 2004
Although patients and families worry about intraoperative complications and death, the vast majority of adverse events occur in the postoperative period
Epidural vs PCA vs intermittent administered morphine:
Cold for acute pain
Heat/cold for chronic pain
Engage nursing, family
To reduce fears, explain cause or mechanism of pain
Engage cooperation and “partner” in management
When prescribing narcotics for the elderly:
Acute onset and fluctuating course
and one of the following:
Altered level of consciousness
Recommend moderately restrictive transfusion guidelines:
Guard against incomplete transfer of information
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