Zusammenfassung
Aufgrund der steigenden Lebenserwartung müssen sich heutzutage immer mehr ältere und
hochbetagte Patienten einer Operation unterziehen – eine Herausforderung für die Chirurgie
und insbesondere für die Anästhesiologie. Dieser Beitrag beschreibt, wie altersbedingte
Besonderheiten präoperativ erfasst und entsprechende Maßnahmen eingeleitet werden
können, um das Risiko der postoperativen Morbidität – oder gar Pflegebedürftigkeit
– zu verringern.
Abstract
With a constantly growing portion of elderly within our population and the advances
of modern medicine, surgery on aged and very aged patients has become a daily hospital
routine. Due to the physical and mental features of ageing these patients face special
perioperative risks. They display a higher rate of complications, morbidity and cognitive
deficits which might in the end lead to persisting need of care. Even in the healthy
elderly, most organ functions are “physiologically” instable or deficient and the
homeostasis of health and disease is fragile. The preoperative evaluation of the aged
patient has to be extended towards risk factors and pathologic pre-conditions which
derive especially from high age and are so far not determined by a mere “fit-for-anaesthesia?”
evaluation. This includes assessment of frailty and functional status as well as the
evaluation of pre-existing cognitive deficits, malnutrition and polypharmacy. Prevention
of postoperative cognitive deficits and delirium is an important goal of medical therapy
and requires i. a. omission of benzodiazepines, BIS-controlled anaesthesia, focus
on patientʼs comfort and orientation and inclusion of close relatives and confidants
in all processes. Considering all this, an elderly patient might require more time
than usually given to be well prepared for anaesthesia, surgery and the postoperative
course. The altered physiology and the special risk profile of the aged patient demand
special attention and time throughout the perioperative phase. With an increasing
number of elderly presenting for surgery, it is likely that more age-adapted structures
and processes become implemented in our hospitals.
Schlüsselwörter
älterer Patient - kognitive Defizite - funktioneller Status - Delir - Angehörige
Key words
elderly patient - cognitive deficits - functional status - delirium - relatives
