GERIATRIC ANESTHESIA: EVALUATING THE IMPACT OF AGE-RELATED PHYSIOLOGICAL CHANGES ON ANAESTHETIC PRACTICES
Abstract
Background: As the global population ages, the number of elderly patients undergoing surgical procedures increases, posing unique challenges for anesthetic management. Age-related physiological changes affect multiple organ systems, impacting the pharmacokinetics and pharmacodynamics of anesthetic agents. Understanding these changes is crucial for optimizing perioperative care in geriatric patients.
Objective: This literature review aims to comprehensively evaluate the impact of age-related physiological changes on anesthetic practices and outcomes in geriatric patients. By synthesizing current research, the review seeks to provide insights into tailored approaches for anesthesia in the elderly population, encompassing hemodynamic management, ventilation strategies, drug selection and dosing, and postoperative care.
Methods: A comprehensive literature search was conducted to identify studies on the impact of age-related physiological changes on aesthetic practices in geriatric patients. Electronic databases were searched using specific keywords. Inclusion criteria encompassed peer-reviewed articles focusing on anesthesia patients aged 65 and older, while exclusion criteria eliminated studies not published in English or those focusing solely on pediatric or adult populations under 65. Data extraction and synthesis involved organizing findings on cardiovascular, respiratory, renal, hepatic, and central nervous system changes, aesthetic implications, and strategies for perioperative management.
Results: Age-related physiological changes significantly influence anesthetic practices in geriatric patients. These changes necessitate tailored approaches to hemodynamic management, ventilation strategies, drug selection and dosing, and postoperative care. Techniques such as regional anesthesia and multimodal analgesia mitigate risks and improve outcomes. Collaborative multidisciplinary care is essential for optimizing perioperative management in elderly patients.
Conclusion: Optimizing anesthetic care in geriatric patients requires a comprehensive understanding of age-related physiological changes and their implications for perioperative management. Tailored approaches that consider these changes, utilize appropriate anesthetic techniques, and implement multidisciplinary care strategies are crucial for improving surgical outcomes and enhancing the quality of life in elderly patients. Ongoing research and education are essential for advancing geriatric anesthesia practice and addressing the evolving needs of this growing patient population.
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Oksuzyan, A., Höhn, A., Pedersen, J., Rau, R., Lindahl-Jacobsen, R., & Christensen K. Preparing for the future: the changing demographic composition of hospital patients in denmark between 2013 and 2050. PLoS One [Internet]. 2020;15(9). Available from: https://doi.org/10.1371/journal.pone.0238912
M. M-AL and D-M. geriatric medicine in the medical curriculum: a must in the globally aging world. J Med Univ St Tomas [Internet]. 2022;6(2):944–51. Available from: ttps://doi.org/10.35460/2546-1621.2022-0061
Heck V., Klug K., Prasse T., Oikonomidis S., Klug A. HB e. al. rojections from surgical use models in germany suggest a rising number of spinal fusions in patients 75 years and older will challenge healthcare systems worldwide. Clin Orthop Relat Res [Internet]. 2023;481(8):1610–9. Available from: https://doi.org/10.1097/corr.0000000000002576
Ginsberg G., Hattis D., Russ A. & SB. pharmacokinetic and pharmacodynamic factors that can affect sensitivity to neurotoxic sequelae in elderly individuals. Environ Health Perspect [Internet]. 2005;113(9):1243–9. Available from: https://doi.org/10.1289/ehp.7568
C. HL and O. changes in pharmacokinetics and pharmacodynamics in the elderly patient. J Pharm Pract [Internet]. 2007;20(1):4–12. Available from: https://doi.org/10.1177/0897190007304657
T. ND and H. perioperative multimodal anesthesia using regional techniques in the aging surgical patient. Pain Res Treat. 2014;1–13.
Singam N., Fine C. & FJ. cardiac changes associated with vascular aging. Clin Cardiol [Internet]. 2019;43(2):92–8. Available from: https://doi.org/10.1002/clc.23313
Steppan J., Barodka V., Berkowitz D. & ND. vascular stiffness and increased pulse pressure in the aging cardiovascular system. Cardiol Res Pract [Internet]. 2011;1–8. Available from: https://doi.org/10.4061/2011/263585
Wang W., Chang W. & CH. the relationship of vascular aging to reduced cognitive function: pulsatile and steady state arterial hemodynamics. Pulse [Internet]. 2022;10(1–4):19–25. Available from: https://doi.org/10.1159/000528147
Šprung J., Gajic O. & WD. Review article: age related alterations in respiratory function — anesthetic considerations. Can J Anesth Can D Anesthésie [Internet]. 2006;53(12):1244–57. Available from: https://doi.org/10.1007/bf03021586
Patel N., Chong K. & BA. Methods and applications in respiratory physiology: respiratory mechanics, drive and muscle function in neuromuscular and chest wall disorders. Front Physiol [Internet]. 2022;13. Available from: https://doi.org/10.3389/fphys.2022.838414
Sasaki N., Meyer M. & EM. postoperative respiratory muscle dysfunction. Anesthesiology [Internet]. 2013;118(4):961–78. Available from: https://doi.org/10.1097/aln.0b013e318288834f
Czarkowska–Pączek B., Mucha K. & PL. age-related decline in renal blood flow could be a beneficial and compensatory mechanism. Med Sci Monit [Internet]. 2020;26. Available from: https://doi.org/10.12659/msm.918643
A. L. fluid and electrolytes in the aged. Arch Surg [Internet]. 2003;138(100):1055. Available from: https://doi.org/10.1001/archsurg.138.10.1055
Musso C., Scibona P., Bellizzi V. & NJ. Impact of renal aging on drug therapy. Postgrad Med [Internet]. 2015;127(6):623–9. Available from: https://doi.org/10.1080/00325481.2015.1063957
H. W. drug metabolism and ageing. Menopause Int [Internet]. 2005;11(2):51–6. Available from: https://doi.org/10.1258/136218005775544589
D. ZJ and P. The aging liver. Gerontology [Internet]. 2002;48(3):121–7. Available from: https://doi.org/10.1159/000052829
Robinson T., Raeburn C., Angles E. & MM. Low tryptophan levels are associated with postoperative delirium in the elderly. Am J Surg [Internet]. 2008;196(5):670–4. Available from: https://doi.org/10.1016/j.amjsurg.2008.07.007
La D., Am R., R Y., Marcantonio E., Xie Z. LK e. al. postoperative delirium and postoperative cognitive dysfunction. Anesthesiology [Internet]. 2019;131(3):477–91. Available from: https://doi.org/10.1097/aln.0000000000002729
Xiao Q., Liu Q., Deng R., Gao Z. & ZY. postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty. Psychogeriatrics [Internet]. 2020;20(4):501–9. Available from: https://doi.org/10.1111/psyg.12516
T. H. perioperative pain management in the elderly surgical patient. Univers J Med Sci [Internet]. 2013;1(2):36–49. Available from: https://doi.org/10.13189/ujmsj.2013.010204
T. ND and H. perioperative multimodal anesthesia using regional techniques in the aging surgical patient. pain Res Treat [Internet]. 2014;2014:1–13. Available from: https://doi.org/10.1155/2014/902174
Egan T. Are opioids indispensable for general anaesthesia? Br J Anaesth [Internet]. 2019;122(6):e127–35. Available from: https://doi.org/10.1016/j.bja.2019.02.018
E. GÉ and T. anaesthesia and postoperative analgesia in older patients with chronic obstructive pulmonary disease. Drugs Aging [Internet]. 2003;20(5):347–60. Available from: https://doi.org/10.2165/00002512-200320050-00004
M. JJ and J. perioperative regional anaesthesia and postoperative longer-term outcomes. F1000research [Internet]. 2016;5(2501). Available from: https://doi.org/10.12688/f1000research.9100.1
Desai S., Law T. & ND. Long-term complications of critical care. Crit Care Med [Internet]. 2011;39(2):371–9. Available from: https://doi.org/10.1097/ccm.0b013e3181fd66e5
Mart M., Roberson S., Salas B., Pandharipande P. & EE. Prevention and management of delirium in the intensive care unit. Semin Respir Crit Care Med [Internet]. 2020;42(1):112–26. Available from: https://doi.org/10.1055/s-0040-1710572
Jildenstål P., Rawal N., Hällén J., Berggren L. & JJ. Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction : results from a swedish web-based survey. Ann Med Surg [Internet]. 2014;3(3):100–7. Available from: https://doi.org/10.1016/j.amsu.2014.07.001
K. GR and M. pulmonary complications in neurosurgical patients. Indian J Neurosurg [Internet]. 2012;01(02):175–80. Available from: https://doi.org/10.4103/2277-9167.102299
Jang M., Shin M. & SY. pulmonary and physical rehabilitation in critically ill patients. Acute Crit care [Internet]. 2019;34(1):1–13. Available from: https://doi.org/10.4266/acc.2019.00444
Ogan, K., Master, V., & Canter D. Perioperative assessment of elderly surgical patients. Curr Transl Geriatr Exp Gerontol Rep [Internet]. 2013;2(2):45–50. Available from: https://doi.org/10.1007/s13670-013-0038-5
A. T. Anaesthesia in the geriatric patient – a case study. Vet Nurs J [Internet]. 2014;29(2):52–3. Available from: https://doi.org/10.1111/vnj.12111
Hu F., O’Mara L., Tulebaev S., Orkaby A., Cooper Z. & BR. geriatric surgical service interventions in older emergency general surgery patients: preliminary results. J Am Geriatr Soc [Internet]. 2022;70(8):404–2414. Available from: https://doi.org/10.1111/jgs.17916
Singam N., Fine C. & FJ. cardiac changes associated with vascular aging. Clin Cardiol [Internet]. 2019;43(2):92–8. Available from: https://doi.org/10.1002/clc.23313
Steppan J., Barodka V., Berkowitz D. & ND. vascular stiffness and increased pulse pressure in the aging cardiovascular system. Cardiol Res Pract [Internet]. 2011;2011:1–8. Available from: https://doi.org/10.4061/2011/263585
M. A. aging-related changes of the cardiovascular system. J Heal Environ Res. 2017;3(2):27.
Hill B., Rakocz N., Rudas Á., Chiang J., Wang S. HI e. al. Imputation of the continuous arterial line blood pressure waveform from non-invasive measurements using deep learning. Sci Rep [Internet]. 2021;11(1). Available from: https://doi.org/10.1038/s41598-021-94913-y
M. B. Noninvasive and minimally invasive cardiac output monitoring. Dimens Crit Care Nurs [Internet]. 2022;41(3):121–3. Available from: https://doi.org/10.1097/dcc.0000000000000524
Stens J., Oeben J., Dusseldorp A. & BC. Non-invasive measurements of pulse pressure variation and stroke volume variation in anesthetized patients using the nexfin blood pressure monitor. J Clin Monit Comput [Internet]. 2015;30(5):587–94. Available from: https://doi.org/10.1007/s10877-015-9759-7
Bogari A., Aldakhil I., Alsuwaidan M., Alhassani N., Alroudan D. AO e. al. Inhalation anaesthetics: types, mechanism of action and adverse effects. Int J Community Med Public Heal [Internet]. 2022;9(12):4684. Available from: https://doi.org/10.18203/2394-6040.ijcmph20223230
Ghatge S., Lee J. & SI. sevoflurane: an ideal agent for adult day‐case anesthesia? Acta Anaesthesiol Scand [Internet]. 2003;47(8):917–31. Available from: https://doi.org/10.1034/j.1399-6576.2003.00196.x
Sivanna U., Joshi S., Babu B. JA. A comparative study of pharmacological myocardial protection between sevoflurane and desflurane at anaesthestic doses in patients undergoing off pump coronary artery bypass grafting surgery. Indian J Anaesth [Internet]. 2015;59(5):282. Available from: https://doi.org/10.4103/0019-5049.156867
Yin K., Ding J., Wu Y. & PM. Goal-directed fluid therapy based on noninvasive cardiac output monitor reduces postoperative complications in elderly patients after gastrointestinal surgery: a randomized controlled trial. Pakistan J Med Sci [Internet]. 2018;34(6). Available from: https://doi.org/10.12669/pjms.346.15854
D. U-S. optimal perioperative fluid management: what is the strategy? Serbian J Anesth Intensive Ther [Internet]. 2016;38(3–4):75–81. Available from: https://doi.org/10.5937/sjait1604075u
J. L. Vascular endothelial growth factor-d plasma levels in fluid overload and cardiac function evaluation of elderly patients with cardiovascular disease. Medicine (Baltimore) [Internet]. 2023;102(46):e36062. Available from: https://doi.org/10.1097/md.0000000000036062
Yanagi S., Tsubouchi H., Miura A., Matsuo A., Matsumoto N. & NM. the impacts of cellular senescence in elderly pneumonia and in age-related lung diseases that increase the risk of respiratory infections. Int J Mol Sci [Internet]. 2017;18(3):503. Available from: https://doi.org/10.3390/ijms18030503
Sato H., Nakamura K., Baba Y., Terada S., Goto T. & KK. low tidal volume ventilation with low peep during surgery may induce lung inflammation. BMC Anesthesiol. 2015;16(1).
S. P. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery. Korean J Anesthesiol [Internet]. 2016;69(1):3. Available from: https://doi.org/10.4097/kjae.2016.69.1.3
Sinclair S., Polissar N. & AW. Spatial distribution of sequential ventilation during mechanical ventilation of the uninjured lung: an argument for cyclical airway collapse and expansion. BMC Pulm Med [Internet]. 2010;10(1). Available from: https://doi.org/10.1186/1471-2466-10-25
Neal J., Bernards C., Hadžić A., Hebl J., Hogan Q. HT e. al. ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. Reg Anesth Pain Med [Internet]. 2008;33(5):404–15. Available from: https://doi.org/10.1097/00115550-200809000-00003
Chen J., Lin J., Chen X. & LC. Efficacy of an intercostal nerve block administered with general anesthesia in elderly patients undergoing distal gastrectomy. Clin Investig Med [Internet]. 2015;38(6):351. Available from: https://doi.org/10.25011/cim.v38i6.26197
Hassanzadeh H., Jain A., Tan E., Stein B., Hoy M. SN e. al. postoperative incentive spirometry use. Orthopedics [Internet]. 2012;35(6). Available from: https://doi.org/10.3928/01477447-20120525-37
Yamana I., Takeno S., Hashimoto T., Maki K., Shibata R. SH e. al. Randomized controlled study to evaluate the efficacy of a preoperative respiratory rehabilitation program to prevent postoperative pulmonary complications after esophagectomy. Dig Surg. 2015;32(5):331–7.
S. FJ, AL-Fayyadh. Preoperative incentive spirometer to prevent postoperative pulmonary complications following open heart surgeries: a randomized single blinded multi-centric clinical trial. J Contemp Med Sci [Internet]. 2022;8(4). Available from: https://doi.org/10.22317/jcms.v8i4.1261
Czarkowska–Pączek B., Mucha K. & PL. age-related decline in renal blood flow could be a beneficial and compensatory mechanism. Med Sci Monit [Internet]. 2020;26. Available from: https://doi.org/10.12659/msm.918643
Verhave J., Fesler P., Cailar G., Ribstein J., Safar M. & MA. Elevated pulse pressure is associated with low renal function in elderly patients with isolated systolic hypertension. Hypertension [Internet]. 2005;45(4):586–91. Available from: https://doi.org/10.1161/01.hyp.0000158843.60830.cf
P. M. Anaesthesia for the patient with impaired renal function. Anaesth Intensive Care [Internet]. 1983;11(4):321-332. Available from: https://doi.org/10.1177/0310057x8301100403
Keßler U., Bjorke-Bertheussen J., Søreide E., Hunderi P., Bache-Mathiesen L. OK e. al. remifentanil as an adjunct to anaesthesia for electroconvulsive therapy fails to confer long-term benefits. Br J Anaesth [Internet]. 2018;121(6):1282–9. Available from: https://doi.org/10.1016/j.bja.2018.07.011
M. O. Preventing renal failure in the critically ill. BMJ [Internet]. 2001;322(7300):1437–9. Available from: https://doi.org/10.1136/bmj.322.7300.1437
M. P. Drug use and nephrotoxicity in the intensive care unit. Kidney Int [Internet]. 2012;81(12):1172–8. Available from: https://doi.org/10.1038/ki.2010.475
A S-GK and Z. Perioperative renal protection. Curr Opin Crit Care [Internet]. 2021;27(6):676–85. Available from: https://doi.org/10.1097/mcc.0000000000000881
Wu. The duration of postoperative acute kidney injury predicts in-hospital mortality in surgical patients. World J Nephrol Urol [Internet]. 2014; Available from: https://doi.org/10.14740/wjnu143w
Gumbert S., Kork F., Jackson M., Vanga N., Ghebremichael S. WC e. al. perioperative acute kidney injury. Anesthesiology [Internet]. 2020;132(1):180–204. Available from: https://doi.org/10.1097/aln.0000000000002968
B D., PADHY S., Girijavani D. & LP. Role of serum creatinine in forecasting the outcome after cardiac surgery beyond acute kidney injury-a cross sectional study. Asian J Pharm Clin Res [Internet]. 2021;105–8. Available from: https://doi.org/10.22159/ajpcr.2021.v14i12.43250
S. A. Effect of changes in metabolic enzymes and transporters on drug metabolism in the context of liver disease: impact on pharmacokinetics and drug–drug interactions. Br J Clin Pharmacol [Internet]. 2024;90(4):942–58. Available from: https://doi.org/10.1111/bcp.15990
E. Eld. Pharmacokinetic-pharmacodynamic crisis in the elderly. Am J Ther [Internet]. 2007;14(5):488–98. Available from: https://doi.org/10.1097/01.mjt.0000183719.84390.4d
Nucera M., Marsili M., Malyan M. & BC. Ketamine, propofol and low dose remifentanil versus propofol and remifentanil for ercp outside the operating room: is ketamine not only a “rescue drug”? Med Sci Monit [Internet]. 2012;18(9):CR575–80. Available from: https://doi.org/10.12659/msm.883354
Ahn J., Kim D., Chung I., Lee J., Lee E. & JJ. Pre-administration of remifentanil in target-controlled propofol and remifentanil anesthesia prolongs anesthesia induction in neurosurgical patients. Medicine (Baltimore) [Internet]. 2019;98(3):e14144. Available from: https://doi.org/10.1097/md.0000000000014144
Jahanbakhsh S., Bameshki A. & KP. remifentanil-induced abdominal pain: a randomised clinical trial. Anaesth Intensive Care [Internet]. 2009;37(3):447–9. Available from: https://doi.org/10.1177/0310057x0903700302
E. C. toxicity of inhalation anaesthetic agents. Br J Anaesth [Internet]. 1978;50(7):665–75. Available from: https://doi.org/10.1093/bja/50.7.665
Barrington M., Weinberg G. & NJ. A call to all readers: educating all surgeons on preventing and treatment of local anaesthetic systemic toxicity. Aust N Z J Surg [Internet]. 2016;86(9):636–7. Available from: https://doi.org/10.1111/ans.13667
Vogt J., Radermacher P. & GM. 13co2 breath tests, a tool to assess intestinal and liver function in the icu? Curr Opin Crit Care [Internet]. 2010;16(2):169–75. Available from: https://doi.org/10.1097/mcc.0b013e3283376739
Tralhão J., Hoti E., Oliveiros B., Abrantes A., Botelho M. & C-SF. Intermittent pringle maneuver and hepatic function: perioperative monitoring by noninvasive icg‐clearance. World J Surg [Internet]. 2009;33(12):2627–34. Available from: https://doi.org/10.1007/s00268-009-0204-2
Simegn A., Melesse D., Bizuneh Y. & AW. perioperative management of patients with liver disease for non-hepatic surgery: a systematic review. Ann Med Surg [Internet]. 2022;75. Available from: https://doi.org/10.1016/j.amsu.2022.103397
Urits I., Orhurhu V., Jones M., Hoyt D., Seats A. & VO. Current perspectives on postoperative cognitive dysfunction in the ageing population. Turkish J Anaesthesiol Reanim [Internet]. 2019;47(6):439–47. Available from: https://doi.org/10.5152/tjar.2019.75299
Y. Z. Safety and efficacy of a low-dose combination of midazolam, alfentanil, and propofol for deep sedation of elderly patients undergoing ercp. BMC Gastroenterol [Internet]. 2024;24(1). Available from: https://doi.org/10.1186/s12876-024-03197-9
Erdoğan M., Demirbilek S., Erdil F., Aydoğan M., Öztürk E. TT e. al. the effects of cognitive impairment on anaesthetic requirement in the elderly. Eur J Anaesthesiol [Internet]. 2012;29(7):326–31. Available from: https://doi.org/10.1097/eja.0b013e32835475c6
Y. L. Impact of sedation protocols on elderly patients undergoing mechanical ventilation and off-line weaning. J Clin Nurs Res [Internet]. 2024;8(4):322–33. Available from: https://doi.org/10.26689/jcnr.v8i4.6861
J. P. Exploring the combination of gabapentinoids and opioids for postoperative analgesia. Jama Netw Open [Internet]. 2020;3(12):e2032139. Available from: https://doi.org/10.1001/jamanetworkopen.2020.32139
Lavin R., Liu C., Yuspeh L., Kalia N., Leung N. TN e. al. Trends in the utilization and dose of gabapentinoids in combination with opioids in an injured worker population between 2008 and 2018. J Occup Environ Med [Internet]. 2021;63(10):e694–700. Available from: https://doi.org/10.1097/jom.0000000000002344
Lee G., Berkowitz R., Hacker S. HJ, A. R. Htx-011 in combination with multimodal analgesic regimen minimized severe pain and opioid use after total knee arthroplasty in an open-label study. J Knee Surg [Internet]. 2022;36(9):925–32. Available from: https://doi.org/10.1055/s-0042-1747945
L. SC and R. Challenges in anaesthesia for elderly. Singapore Dent J [Internet]. 2014;35:23–9. Available from: https://doi.org/10.1016/j.sdj.2014.11.003
S. KD and M. Neurocognitive function monitoring. J Neuroanaesth Crit Care [Internet]. 2015;2(3):246–56. Available from: https://doi.org/10.4103/2348-0548.165055
Evered L., Silbert B. & SD. The impact of the peri‐operative period on cognition in older individuals. J Pharm Pract Res [Internet]. 2015;45(1):93–9. Available from: https://doi.org/10.1002/jppr.1069
Kakinuma K., Kakinuma T., Shinohara T., Shimizu A., Okamoto R. KA e. al. management of giant ovarian tumors in elderly adults: preoperative evaluation using comprehensive geriatric assessment and estimation of physiologic ability and surgical stress and perioperative management effectiveness using aron alpha method and enhance. 2023; Available from: https://doi.org/10.21203/rs.3.rs-2430620/v1
W. L, Y. F, W. C. Effects of combined spinal epidural anesthesia in orthopaedic surgery of elderly patients. Comput Math Methods Med [Internet]. 2022;2022:1–5. Available from: https://doi.org/10.1155/2022/3523172
T. ND and H. Perioperative multimodal anesthesia using regional techniques in the aging surgical patient. Pain Res Treat [Internet]. 2014;1–13. Available from: https://doi.org/10.1155/2014/902174
Liu S., Ngeow J. & YJ. ultrasound-guided regional anesthesia and analgesia. Reg Anesth Pain Med [Internet]. 2009;34(1):47–59. Available from: https://doi.org/10.1097/aap.0b013e3181933ec3
J. F. Effects of ultrasound-guided lumbar plexus and sacral plexus block combined with general anesthesia on the anesthetic efficacy and surgical outcomes in elderly patients undergoing intertrochanteric fracture surgery: a randomized controlled trial. J Orthop Surg Res [Internet]. 2024;19(1). Available from: https://doi.org/10.1186/s13018-023-04469-y
P. W, H. K. Improving postoperative pain management. Anesthesiology [Internet]. 2010;112(1):220–5. Available from: https://doi.org/10.1097/aln.0b013e3181c6316e
Girard P., Chauvin M. & VM. Nefopam analgesia and its role in multimodal analgesia: a review of preclinical and clinical studies. Clin Exp Pharmacol Physiol [Internet]. 2015;43(1):3–12. Available from: https://doi.org/10.1111/1440-1681.12506
Yeo J., Park J., Choi G., Kim H., Kim J. OJ e. al. Comparison of the analgesic efficacy of opioid‐sparing multimodal analgesia and morphine‐based patient‐controlled analgesia in minimally invasive surgery for colorectal cancer. World J Surg [Internet]. 2022;46(7):1788–95. Available from: https://doi.org/10.1007/s00268-022-06473-5
Z. DA and S. problematic opioid use among older adults: epidemiology, adverse outcomes and treatment considerations. Drugs Aging [Internet]. 2021;38(12):1043–53. Available from: https://doi.org/10.1007/s40266-021-00893-z
Rekatsina M., Paladini A., Myrcik D., Viswanath O., Urits I. PJ e. al. opioids in the elderly patients with cognitive impairment: a narrative review. 2021; Available from: https://doi.org/10.20944/preprints202112.0468.v1
Wang H., Yi S., Wang H. & CM. Process management of analgesia and sedation can reduce the incidence of delirium. Surg Sci [Internet]. 2019;10(11):405–11. Available from: https://doi.org/10.4236/ss.2019.1011045
C. S, J. P. Evidence‐based strategies to reduce the incidence of postoperative delirium: a narrative review. Anaesthesia [Internet]. 2022;77(S1):92–101. Available from: https://doi.org/10.1111/anae.15607
Huang P., Sun S. & LH. The effect of anesthesia depth monitoring on postoperative delirium and postoperative cognitive dysfunction in non-cardiac surgery patients---- a systematic review and meta-analysis. 2021; Available from: https://doi.org/10.21203/rs.3.rs-439899/v1
L. SF and B. non‐pharmacologic interventions for the prevention of delirium in the intensive care unit: an integrative review. Nurs Crit Care [Internet]. 2021;26(3):166–75. Available from: https://doi.org/10.1111/nicc.12594
Chitnis S., Tang R. & ME. The role of regional analgesia in personalized postoperative pain management. Korean J Anesthesiol [Internet]. 2020;73(5):363–71. Available from: https://doi.org/10.4097/kja.20323
A. JR and S. Development of a multimodal analgesia protocol for perioperative acute pain management for lower limb amputation. pain Res Manag [Internet]. 2018;1–9. Available from: https://doi.org/10.1155/2018/5237040
S. P. pain and sedation assessment. 2015;749–53. Available from: https://doi.org/10.1016/b978-1-4557-0306-7.00141-0
Al‐Dorzi H., AlQahtani S., Al‐Dawood A., Al-Hameed F., Burns K. MS e. al. Association of early mobility with the incidence of deep-vein thrombosis and mortality among critically ill patients: a post hoc analysis of prevent trial. Crit Care [Internet]. 2023;27(1). Available from: ttps://doi.org/10.1186/s13054-023-04333-9
Walker N., Rodgers A., Birchall N., Norton R. & MS. Leg ulceration as a long-term complication of deep vein thrombosis. J Vasc Surg [Internet]. 2003;38(6):1331–5. Available from: https://doi.org/10.1016/s0741-5214(03)00917-0
DOI: https://doi.org/10.33508/jwmj.v6i3.5764
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