Q: I have heard that as you get older there are more risks when undergoing anesthesia. What are they?
A: As the new year approaches, many individuals are considering elective surgeries. This is an opportune time to reflect on your own health status.
With aging, individuals often encounter medical issues related to cardiovascular, pulmonary or neurological conditions. It is important to discuss these issues with your healthcare provider before undergoing anesthesia for surgical procedures. A skilled team of anesthesia and medical professionals can implement various precautions and safety measures to ensure a safe outcome, regardless of age.
Geriatric anesthesia focuses on providing specialized anesthesia care for adults over the age of 65, ensuring their comfort during surgery. While the risks associated with anesthesia can depend on a patient’s medical condition and the type of surgery being performed, age can complicate predictions about how the body will respond to surgical stress. According to Andreas Loepke, associate professor of clinical anesthesia at the University of Cincinnati College of Medicine, anesthetic medications can have significant side effects, including respiratory depression, loss of protective airway reflexes, blood pressure instability, nausea and vomiting. Common age-related conditions such as hypertension and heart disease can further increase the likelihood of complications during and after surgery.
Although anesthesia is generally safe when administered by qualified professionals, older adults are at an elevated risk for various complications affecting multiple bodily systems. It is essential for patients and their families to engage in discussions about these risks and the measures in place to mitigate them, paving the way for informed decisions regarding surgical care.
Physiological risks
Hypothermia: Older patients may have a reduced ability to regulate body temperature during surgery.
Dehydration and electrolyte Imbalance: Preoperative fasting and fluid management can lead to dehydration or electrolyte disturbances.
Delayed drug metabolism: Age-related changes in liver and kidney function affect the movement of a drug into, through and out of the human body, which can inhibit drug clearance and metabolism, leading to prolonged effects of anesthetics.
Cardiovascular risks
Arrhythmias: Anesthesia can provoke irregular rhythms, particularly in those with pre-existing heart conditions.
Hypotension: Anesthetic agents can lead to widening of blood vessels and decreased blood pressure, potentially more pronounced in older patients.
Myocardial infarction: Increased risk of cardiac events (heart attack), especially in patients with existing cardiovascular disease.
Heart failure: Anesthesia may increase risk of heart failure due to fluid shifts and mood changes following surgery.
Pulmonary risks
Respiratory depression: Anesthetic agents can depress respiratory function, leading to a reduced heart rate with more carbon dioxide and too little oxygen available to the body.
Pneumonia: Increased risk of postoperative pneumonia due to impaired respiratory function.
Neurological risks
Delirium: Postoperative delirium is common in older patients..
Cognitive dysfunction: Anesthesia may lead to postoperative cognitive decline or worsen existing dementia.
Renal risks
Acute Kidney Injury (AKI): Risk of AKI may increase due to reduced passage of fluids through circulatory or lymphatic systems, or underlying kidney insufficiencies.
Fluid overload: Difficulty in managing fluid balance can lead to a collection of excess fluids and increased kidney workload.
Additional complications
Skin damage: Increased susceptibility to surgical site infections.
Thromboembolism: Risk for a blood clot that starts in a vein from changes to blood flow.
Comprehensive planning is crucial
While further research is needed to fully understand the effects of anesthesia on brain and physical functions, it is crucial for healthcare providers to perform comprehensive preoperative assessments. These evaluations help identify potential risks, particularly in advanced-age patients. Implementing tailored anesthetic techniques, vigilant monitoring, and effective postoperative care can significantly reduce the likelihood of complications.
If you or a loved one is scheduled for surgery, it is important to address any concerns you may have. Rather than worrying unnecessarily, focus on making informed decisions based on the patient’s overall health status. Engaging in open discussions with healthcare providers can lead to better understanding and management of anesthesia-related risks.
Karen Casanovas, PCC, CPCC, CLIPP is a health and wellness professional coach practicing in Anchorage. If you have questions write to her at info@karencasanovas.com.
