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Geriatric anaesthesia (Physiological considerations (Cardiovascular…

- - - - Predominantly compensate for hypotension via tachycardia
    - - Slower onset/less effective baroreceptor reflexes/vasoconstriction. Results in inability to adequately compensate for hypotension. Increases risk of hypotensive drugs (ACP, Alpha-2s, Iso etc).
    - - Especially with CHF/pulmonary oedema
  - - - Prolonged half-life of drugs eliminated by the kidneys
      - Reduced Na conservation and H+ excretion
  - - - Extended half-life of agents eliminated by the liver
  - - - Higher VOD for lipophilic drugs, resulting in prolonged recoveries. Smaller VOD for hydrophilic drugs (NSAIDs), so greater effect.
  - - - Costochondral ossification reduces thoracic wall compliance
      - Reduced capacity, elasticity and compliance of lungs
    - - Increased risk of hypoxaemia/hypercapnia.
    - - Decreased tidal volume
- - - - Minor CVS depression
      - Dose-dependant respiratory depression
      - Urinary retention
      - Morphine can cause vomiting/histamine release
      - Preemptive analgesia
    - - Generally used if additional sedation required
      - CNS dopamine antagonist, PNS alpha-1 antagonist (vasodilation, bladder sphincter relaxation).
    - - Minor CVS/Resp depression
      - Good sedation and muscle relaxation
    - - Short DOA (< 30 mins)
      - Preemptive analgesia
      - Increases HR/CO via inotropy - elevated myocardial oxygen requirement
      - Contraindicated with CVS disease or glaucoma
      - Hypertonia
    - - Benzodiazepine + opioid
      - Low-dose ACP + benzodiazepine + opioid
      - Reduces individual doses and side-effects of drugs