FOR THE ELDERLY


•  Take into account longer duration of action in elderly


• Neuromuscular blocking agents


• Duration prolonged by ↑ age (if steroid based), mild hypothermia, increased density of block (train-of-four ratio ≤1 during anesthetic), potent inhaled agents, diabetes mellitus, obesity (if dose based on TBW), respiratory acidosis (spontaneous ventilation prior to reversal of block)


• Avoid pancuronium in patients who are to be extubated at case end


• Difficult to reverse and sustain train-of-four ratio ≥ 0.9 in PACU


• Use short- or intermediate-acting neuromuscular blockers


• Consider cisatracurium if ↑ creatinine


• Do not follow rocuronium with cisatracurium (significant potentiation and prolongation of effect)


• Meperidine: Avoid meperidine (except 10–20 mg IV to treat shivering)


• Accumulates with repeat dosing


• Active, toxic (seizures) metabolite


• Anticholinergic activity → tachycardia, agitation


• Acute serotonergic syndrome with MAO inhibitors


• Midazolam: Drastically reduce dose/eliminate in patients 75 yrs


•  Specific anesthetic adjuvants


• Metoclopramide, droperidol: May → extrapyramidal effects


• Ketorolac: Avoid in elderly with ↑ serum creatinine


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Aug 28, 2016 | Posted by in ANESTHESIA | Comments Off on FOR THE ELDERLY

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