Cardiopulmonary aspects of anaesthesia for the elderly

Tomás B. Corcoran, Samuel Hillyard

Research output: Contribution to journalReview ArticleResearchpeer-review

16 Citations (Scopus)

Abstract

Normal ageing of the cardiopulmonary system overlaps with the development of cardiovascular disease. It is characterised by changes which decrease cardiovascular reserve through senescent changes in myocardial function and volumes. These changes are compounded by co-existing cardiovascular disease, multisystem co-morbidities and polypharmacy. Indices of vascular ageing permit risk prediction in the perioperative setting. The investigation of these changes using arterio-ventricular coupling has highlighted preload sensitivity and beta-adrenergic and baroreflex insensitivity as the cardinal features which influence cardiovascular performance. Anaesthesia interferes with each of the components and poses substantial challenges. Comprehensive preoperative evaluation and optimisation assist in choosing an individualised approach. This approach, outlined here, must aim where possible to maintain tight haemodynamic control and to limit exhaustion of cardiopulmonary reserve.

Original languageEnglish
Pages (from-to)329-354
Number of pages26
JournalBest Practice and Research: Clinical Anaesthesiology
Volume25
Issue number3
DOIs
Publication statusPublished - Sep 2011
Externally publishedYes

Keywords

  • anaesthesia
  • arterio-ventricular coupling
  • arteriosclerosis
  • beta blockade
  • diastolic dysfunction
  • echocardiography
  • hypertension
  • myocardium

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