Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-55f67697df-xq6d9 Total loading time: 0 Render date: 2025-05-08T17:04:48.118Z Has data issue: false hasContentIssue false

13 - Geriatric Trauma: Principles and Anesthetic Considerations

from Section 3 - Intraoperative Considerations

Published online by Cambridge University Press:  06 January 2018

By
Varun Rimmalapudi ,
Michael C. Lewis  and
Carol Ann B. Diachun
Edited by
Sheila Ryan Barnett  and
Sara E. Neves
Sheila Ryan Barnett
Affiliation:
Harvard University Medical School, Massachusetts
Sara E. Neves
Affiliation:
Beth Israel Deaconess Medical Center, Boston, MA, USA
Get access
Type
Chapter
Information
Perioperative Care of the Elderly Patient , pp. 149 - 157
Publisher: Cambridge University Press
Print publication year: 2018

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

CDC. National Vital Statistics Reports. 2013. Available from: www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf (Accessed July 13, 2017).Google Scholar
CDC. Ten leading causes of death and injury. 2015. Available from: www.cdc.gov/injury/wisqars/leadingcauses.html (Accessed July 13, 2017).Google Scholar
Pandya, SR, Yelon, JA, Sullivan, TS, Risucci, DA. Geriatric motor vehicle collision survival: the role of institutional trauma volume. J Trauma. 2011; 70(6):1326–1330.Google ScholarPubMed
Travis, KW, Mihevc, NT, Orkin, FK, Zeitlin, GL. Age and anesthetic practice: a regional perspective. J Clin Anesth. 1999; 11(3):175–186.CrossRefGoogle Scholar
Frankenfield, D, Cooney, RN, Smith, JS, Rowe, WA. Age-related differences in the metabolic response to injury. J Trauma. 2000; 48(1):49–56; discussion 56–57.CrossRefGoogle ScholarPubMed
Hashmi, A, Ibrahim-Zada, I, Rhee, P, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014; 76(3):894–901.CrossRefGoogle ScholarPubMed
Knudson, MM, Lieberman, J, Morris, JA Jr., Cushing, BM, Stubbs, HA. Mortality factors in geriatric blunt trauma patients. Arch Surg. 1994; 129(4):448–453.CrossRefGoogle ScholarPubMed
Shulman, CI, Alouidor, R, McKenney, MG. Geriatric trauma. In: Feliciano, DV, Matox, KL, Moore, EE, eds., Trauma, 6th edn. New York, McGraw-Hill Medical, 2008.Google Scholar
Caterino, JM, Valasek, T, Werman, HA. Identification of an age cutoff for increased mortality in patients with elderly trauma. Am J Emerg Med. 2010; 28(2):151–158.CrossRefGoogle ScholarPubMed
Joseph, B, Pandit, V, Zangbar, B, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg. 2014; 149(8):766–772.CrossRefGoogle ScholarPubMed
Ting, B, Zurakowski, D, Herder, L, et al. Preinjury ambulatory status is associated with 1-year mortality following lateral compression Type I fractures in the geriatric population older than 80 years. J Trauma Acute Care Surg. 2014; 76(5):1306–1309.CrossRefGoogle ScholarPubMed
Banks, SE, Lewis, MC. Trauma in the elderly: considerations for anesthetic management. Anesthesiol Clin. 2013; 31(1):127–139.CrossRefGoogle ScholarPubMed
Qato, DM, Alexander, GC, Conti, RM, et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008; 300(24):2867–2878.Google ScholarPubMed
The Slone Survey. Patterns of medication use in the United States 2006. 2006. Available from: www.bu.edu/slone/files/2012/11/SloneSurveyReport2006.pdf (Accessed July13, 2017).Google Scholar
Franko, J, Kish, KJ, O'Connell, BG, Subramanian, S, Yuschak, JV. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma. 2006; 61(1):107–110.CrossRefGoogle ScholarPubMed
Ivascu, FA, Janczyk, RJ, Junn, FS, et al. Treatment of trauma patients with intracranial hemorrhage on preinjury warfarin. J Trauma. 2006; 61(2):318–321.CrossRefGoogle ScholarPubMed
Karni, A, Holtzman, R, Bass, T, et al. Traumatic head injury in the anticoagulated elderly patient: a lethal combination. Am Surg. 2001; 67(11):1098–1100.CrossRefGoogle Scholar
Neideen, T, Lam, M, Brasel, KJ. Preinjury beta blockers are associated with increased mortality in geriatric trauma patients. J Trauma. 2008; 65(5):1016–1020.Google ScholarPubMed
Arbabi, S, Campion, EM, Hemmila, MR, et al. Beta-blocker use is associated with improved outcomes in adult trauma patients. J Trauma. 2007; 62(1):56–61; discussion 61–62.CrossRefGoogle ScholarPubMed
Arbabi, S, Ahrns, KS, Wahl, WL, et al. Beta-blocker use is associated with improved outcomes in adult burn patients. J Trauma. 2004; 56(2):265–269; discussion 269–271.CrossRefGoogle ScholarPubMed
Cotton, BA, Snodgrass, KB, Fleming, SB, et al. Beta-blocker exposure is associated with improved survival after severe traumatic brain injury. J Trauma. 2007; 62(1):26–33; discussion 33–35.CrossRefGoogle ScholarPubMed
Grossman, MD, Miller, D, Scaff, DW, Arcona, S. When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma. J Trauma. 2002; 52(2):242–246.Google Scholar
Ferraris, VA, Ferraris, SP, Saha, SP. The relationship between mortality and preexisting cardiac disease in 5,971 trauma patients. J Trauma. 2010; 69(3):645–652.Google ScholarPubMed
Ang, D, Norwood, S, Barquist, E, et al. Geriatric outcomes for trauma patients in the state of Florida after the advent of a large trauma network. J Trauma Acute Care Surg. 2014; 77(1):155–160; discussion 160.CrossRefGoogle ScholarPubMed
Mangram, AJ, Mitchell, CD, Shifflette, VK, et al. Geriatric trauma service: a one-year experience. J Trauma Acute Care Surg. 2012; 72(1):119–122.CrossRefGoogle Scholar
Chang, DC, Bass, RR, Cornwell, EE, Mackenzie, EJ. Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg. 2008; 143(8):776–781; discussion 782.CrossRefGoogle ScholarPubMed
Phillips, S, Rond, PC III, Kelly, SM, Swartz, PD. The failure of triage criteria to identify geriatric patients with trauma: results from the Florida Trauma Triage Study. J Trauma. 1996; 40(2):278–283.CrossRefGoogle ScholarPubMed
American College of Surgeons. Resources for optimal care of the injured patient 2014. 2015. Available from: www.facs.org/quality%20programs/trauma/vrc/resources (Accessed July 13, 2015).Google Scholar
McCoy, CE, Chakravarthy, B, Lotfipour, S. Guidelines for field triage of injured patients: in conjunction with the morbidity and mortality weekly report published by the Center for Disease Control and Prevention. West J Emerg Med. 2013; 14(1):69–76.CrossRefGoogle ScholarPubMed
Demetriades, D, Sava, J, Alo, K, et al. Old age as a criterion for trauma team activation. J Trauma. 2001; 51(4):754–756; discussion 756–757.CrossRefGoogle ScholarPubMed
Lehmann, R, Beekley, A, Casey, L, Salim, A, Martin, M. The impact of advanced age on trauma triage decisions and outcomes: a statewide analysis. Am J Surg. 2009; 197(5):571–574; discussion 574–575.CrossRefGoogle ScholarPubMed
Muhlberg, W, Platt, D. Age-dependent changes of the kidneys: pharmacological implications. Gerontology. 1999; 45(5):243–253.CrossRefGoogle ScholarPubMed
Buemi, M, Nostro, L, Aloisi, C, et al. Kidney aging: from phenotype to genetics. Rejuvenation Res. 2005; 8(2):101–109.CrossRefGoogle ScholarPubMed
Peeters, RP. Thyroid hormones and aging. Hormones (Athens). 2008; 7(1):28–35.CrossRefGoogle ScholarPubMed
Chau, DL, Walker, V, Pai, L, Cho, LM. Opiates and elderly: use and side effects. Clin Interv Aging. 2008; 3(2):273–278.CrossRefGoogle ScholarPubMed
Linnebur, SA, O'Connell, MB, Wessell, AM, et al. Pharmacy practice, research, education, and advocacy for older adults. Pharmacotherapy. 2005; 25(10):1396–1430.CrossRefGoogle ScholarPubMed
Rastogi, R, Meek, BD. Management of chronic pain in elderly, frail patients: finding a suitable, personalized method of control. Clin Interv Aging. 2013; 8:37–46.CrossRefGoogle ScholarPubMed
Arain, SR, Kern, S, Ficke, DJ, Ebert, TJ. Variability of duration of action of neuromuscular-blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005; 49(3):312–315.CrossRefGoogle ScholarPubMed
Sagir, O, Yucesoy Noyan, F, Koroglu, A, Cicek, M, Ilksen Toprak, H. Comparison between the effects of rocuronium, vecuronium, and cisatracurium using train-of-four and clinical tests in elderly patients. Anesth Pain Med. 2013; 2(4):142–148.CrossRefGoogle ScholarPubMed
Cope, TM, Hunter, JM. Selecting neuromuscular-blocking drugs for elderly patients. Drugs Aging. 2003; 20(2):125–140.CrossRefGoogle ScholarPubMed
Narang, AT, Sikka, R. Resuscitation of the elderly. Emerg Med Clin North Am. 2006; 24(2):261–272, v.Google ScholarPubMed
Zaugg, M, Lucchinetti, E. Respiratory function in the elderly. Anesthesiol Clin North Am. 2000; 18(1):47–58, vi.CrossRefGoogle ScholarPubMed
Chalfin, DB. Outcome assessment in elderly patients with critical illness and respiratory failure. Clin Chest Med. 1993; 14(3):583–589.CrossRefGoogle ScholarPubMed
Lomoschitz, FM, Blackmore, CC, Mirza, SK, Mann, FA. Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries. AJR Am J Roentgenol. 2002; 178(3):573–577.CrossRefGoogle ScholarPubMed
Wisner, DH. A stepwise logistic regression analysis of factors affecting morbidity and mortality after thoracic trauma: effect of epidural analgesia. J Trauma. 1990; 30(7):799–804; discussion 804–805.CrossRefGoogle ScholarPubMed
Heffernan, DS, Thakkar, RK, Monaghan, SF, et al. Normal presenting vital signs are unreliable in geriatric blunt trauma victims. J Trauma. 2010; 69(4):813–820.Google ScholarPubMed
Salottolo, KM, Mains, CW, Offner, PJ, Bourg, PW, Bar-Or, D. A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs. Scand J Trauma Resusc Emerg Med. 2013; 21:7.CrossRefGoogle ScholarPubMed
Callaway, DW, Shapiro, NI, Donnino, MW, Baker, C, Rosen, CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009; 66(4):1040–1044.Google ScholarPubMed
McNab, A, Burns, B, Bhullar, I, Chesire, D, Kerwin, A. A prehospital shock index for trauma correlates with measures of hospital resource use and mortality. Surgery. 2012; 152(3):473–476.CrossRefGoogle ScholarPubMed
Ramaiah, R, Lam, AM. Postoperative cognitive dysfunction in the elderly. Anesthesiol Clin. 2009; 27(3):485–496.CrossRefGoogle ScholarPubMed
Meguro, K, Shimada, M, Yamaguchi, S, et al. Cognitive function and frontal lobe atrophy in normal elderly adults: implications for dementia not as aging-related disorders and the reserve hypothesis. Psychiatry Clin Neurosci. 2001; 55(6):565–572.CrossRefGoogle Scholar
Brody, H. The aging brain. Acta Neurol Scand Suppl. 1992; 137:40–44.CrossRefGoogle ScholarPubMed
Thal, DR, Del Tredici, K, Braak, H. Neurodegeneration in normal brain aging and disease. Sci Aging Knowledge Environ. 2004; 2004(23):pe26.CrossRefGoogle ScholarPubMed
Carpenter, CR, DesPain, B, Keeling, TN, Shah, M, Rothenberger, M. The Six-Item Screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med. 2011; 57(6):653–661.CrossRefGoogle ScholarPubMed
Vaughan, MS, Vaughan, RW, Cork, RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981; 60(10):746–751.CrossRefGoogle ScholarPubMed
Rajagopalan, S, Mascha, E, Na, J, Sessler, DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008; 108(1):71–77.CrossRefGoogle ScholarPubMed
Sessler, DI, Akca, O. Nonpharmacological prevention of surgical wound infections. Clin Infect Dis. 2002; 35(11):1397–1404.CrossRefGoogle ScholarPubMed
Frank, SM, Higgins, MS, Breslow, MJ, et al. The catecholamine, cortisol, and hemodynamic responses to mild perioperative hypothermia: a randomized clinical trial. Anesthesiology. 1995; 82(1):83–93.CrossRefGoogle ScholarPubMed
Frank, SM, Fleisher, LA, Breslow, MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997; 277(14):1127–1134.CrossRefGoogle ScholarPubMed
Chaiwat, O, Lang, JD, Vavilala, MS, et al. Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. Anesthesiology. 2009; 110(2):351–360.CrossRefGoogle ScholarPubMed
Croce, MA, Tolley, EA, Claridge, JA, Fabian, TC. Transfusions result in pulmonary morbidity and death after a moderate degree of injury. J Trauma. 2005; 59(1):19–23; discussion 23–24.CrossRefGoogle ScholarPubMed
Claridge, JA, Sawyer, RG, Schulman, AM, McLemore, EC, Young, JS. Blood transfusions correlate with infections in trauma patients in a dose-dependent manner. Am Surg. 2002; 68(7):566–572.CrossRefGoogle ScholarPubMed
Inouye, SK. Delirium in older persons. N Engl J Med. 2006; 354(11):1157–1165.CrossRefGoogle ScholarPubMed
Bitsch, M, Foss, N, Kristensen, B, Kehlet, H. Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review. Acta Orthop Scand. 2004; 75(4):378–389.CrossRefGoogle ScholarPubMed
Inouye, SK, Bogardus, ST Jr., Charpentier, PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999; 340(9):669–676.CrossRefGoogle ScholarPubMed
Monk, TG, Weldon, BC, Garvan, CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology. 2008; 108(1):18–30.CrossRefGoogle ScholarPubMed
Bourne, RS, Tahir, TA, Borthwick, M, Sampson, EL. Drug treatment of delirium: past, present and future. J Psychosom Res. 2008; 65(3):273–282.CrossRefGoogle ScholarPubMed
Egbert, AM. Postoperative pain management in the frail elderly. Clin Geriatr Med. 1996; 12(3):583–599.CrossRefGoogle ScholarPubMed
Zhu, SH, Ji, MH, Gao, DP, Li, WY, Yang, JJ. Association between perioperative blood transfusion and early postoperative cognitive dysfunction in aged patients following total hip replacement surgery. Ups J Med Sci. 2014; 119(3):262–267.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×