Anesthesia and the Senior Citizen
While 70 may be the new 50, inevitable changes in our bodies as we age affect a number of things, particularly our response to medications and Anesthesia. Anesthesia today is safer than ever before for all age groups and for ambulatory outpatients as well as hospitalized patients. Review the relevant topics in this section and the section Information for Our Patients.
If you are an outpatient, it is essential that you arrange for a reliable adult to take you home and stay with you because your coordination, decision-making ability and driving skills may be impaired for up to 48 hours.
A history of Stroke (CVA), Transient Ischemic Attack (TIA), carotid artery narrowing or prior carotid artery surgery can affect your anesthetic plan. Please discuss these problems with your Surgeon, Primary Care Physician or Neurologist, and prior to the day of surgery, our Pre-Admission Testing (PAT) nurse during the week before your scheduled surgery/procedure. Any recent tests such as a carotid ultrasound along with a note from your treating physician or neurologist will be helpful in our plan for your anesthetic.
Diabetes is a frequent diagnosis among our surgical patients. Poorly controlled blood sugar has adverse effects on a variety of responses to surgery and anesthesia including increased risk of surgical wound infection, diminished healing and cardiac complications. While medical literature supports tighter control of blood sugar on a routine basis, our goal is to keep your blood sugar in a more moderate range during your anesthetic care.
Our Pre-Admission Testing (PAT) nurse will talk to you during the week before your surgery/procedure to review what medications you are taking and discuss how to manage your diabetes around the time of surgery (such as the impact of fasting before surgery on your blood sugar levels).
If you are taking insulin, we will want to know what types of insulin you use and the general range of your blood sugar in the morning, afternoon and evening. Ideally, bring your insulin with you on the day of surgery. Patients who use an insulin pump may want to talk to their Primary Care Physician or Endocrinologist regarding settings to use on the day of surgery.
Metformin (Glucophage) is commonly used to treat Adult Onset Diabetes and should be discontinued 48-72 hours before surgery unless otherwise instructed.
As a general rule, we want your blood sugar to be less that 200 mg/dl on the day of surgery. If this may be a problem, be sure to bring it up with your surgeon and our PAT nursing staff and we will help you with solutions.
If you have a history of problems with your heart, it is most important to tell your surgeon and anesthesiologist. Make sure you notify your Primary Care Physician and Cardiologist as they may request additional testing before clearing you for surgery.
For patients with a history of Coronary Artery Disease or MI (heart attack), whether you are treated with medications, have had stents placed or undergone open heart surgery, it is best to see your Cardiologist for guidance regarding your medications and the need for pre-operative testing. Usually, if it has been more than a year since you last saw your Cardiologist, if you have an appointment scheduled during the next 3 months, or if you have experienced a change in your symptoms (chest pain, indigestion, shortness of breath, increasing fatigue), you should see your Cardiologist before proceeding with surgery.
If you have a Pacemaker/Defibrillator device please see the section below related to this subject.
Our Pre-Admission Testing (PAT) nurse will review your history during the week prior to your surgery/procedure, and, with an anesthesiologist, provide the necessary guidance regarding needed testing and use of your medications.
Patients with Pacemakers/ICD devices: If you have a pacemaker (with or without an internal defibrillator), it is important that we have documentation from your cardiologist regarding your cardiac diagnosis, follow up care, and pacemaker/ICD inspections. Please advise the Pre-Admission Testing (PAT) nurse of this fact so that we can obtain your records prior to the day of surgery. We may also need to consult your cardiologist as well as contact the manufacturer of the device for its programming prior to your surgery. Always carry your pacemaker/ICD identification card with you at all times. Lastly, it is important that your surgeon is fully aware that you have this device.
On the day of surgery, your anesthesiologist will obtain a complete history and discuss the plan for managing your pacemaker/ICD device. It is possible that a cardiologist and/or device manufacturer representative will see you during your preoperative period. Depending on the type of surgery, a round magnet may be placed over your device on your chest. It is also possible that your device will be temporarily reprogrammed.
Due to the various cardiac devices available, it is important your anesthesiologist is completely informed so that your care is never compromised.
High Blood Pressure
It is important to keep your blood pressure in your normal range during anesthesia. We use a variety of medications during surgery to make this possible. One important part of this plan is to make sure you continue taking your blood pressure medications through the morning of surgery. You can take your morning blood pressure medications with a sip of water.
If you are taking a type of blood pressure medication called a beta-blocker, it is particularly important to continue these medications prior to your surgery or procedure.
During the week before your surgery, review your blood pressure medications with your Surgeon and your Primary Care Physician. A nurse from our Pre-Admission Testing (PAT) unit will usually call you as well to provide guidance and answer questions.
Obstructive Sleep Apnea
Sleep Apnea is a condition in which breathing is repeatedly interrupted during sleep. Symptoms include loud snoring, frequent awakening at night – often startled or short of breath – and fatigue and sleepiness during waking hours. There are various causes for Sleep Apnea. Although it is often associated with being overweight, it may be a problem for patients who are of normal weight and is often undiagnosed.
Surgery, Anesthesia and the medications used during the procedure and at home for pain can increase the severity of Sleep Apnea. Please read the links related to this subject below and review symptoms you may have with your Surgeon and the Pre-Admission Testing (PAT) nurse. If you are using a Continuous Positive Airway Pressure (CPAP) device, bring it with you to the hospital/surgery center and your Anesthesiologist will discuss treatment considerations with you and your family.
No matter how much you enjoy it, smoking is not good for your health. This is particularly true when you are undergoing surgery or have medical procedures performed. While we strongly encourage you to stop smoking for the long term, discontinuing your use of cigarettes immediately before and after surgery will greatly improve your chances of having a positive result. One cigarette, all by itself, changes various functions in your body for two hours resulting in increased risk for surgical wound infection and reduced healing.
Even if you smoke 10 cigarettes per day (a half pack), your body will function in this compromised manner for most of the day.
Please refrain from the use of cigarettes on the day of surgery and do everything you can to stop/cut back during the weeks before your surgery/procedure. Please refer to the link below from the American Society of Anesthesiologists to help quit your smoking habit. Your anesthesiologist can discuss this topic further on the day of your surgery. You can do it.