ISSN (print) 1726-9806     ISSN (online) 1818-474X
No. 3 (2022), CLINICAL GUIDELINES
No. 3 (2022)
CLINICAL GUIDELINES

Perioperative management of elderly and senile patients. Recommendations

Published 29.08.2022
Igor B. Zabolotskikh
Kuban State Medical University, Krasnodar, Russia; Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
https://orcid.org/0000-0002-3623-2546
E.S. Gorobets
N.N. Blokhin Russian Cancer Research Center, Moscow, Russia
https://orcid.org/0000-0002-9311-2153
E.V. Grigoryev
Kemerovo State Medical University, Kemerovo, Russia
https://orcid.org/0000-0001-8370-3083
Yu.V. Kotovskaya
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-1628-5093
K.M. Lebedinskii
Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia; North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
https://orcid.org/0000-0002-5752-4812
T.S. Musaeva
Kuban State Medical University, Krasnodar, Russia
https://orcid.org/0000-0001-9285-852X
E.A. Mkhitaryan
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0003-2597-981X
A.M. Ovechkin
Sechenov First Moscow State Medical University, Moscow, Russia
https://orcid.org/0000-0002-3453-8699
V.S. Ostapenko
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0003-1222-3351
A.V. Rozanov
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-5313-2715
N.K. Runikhina
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0001-5272-0454
O.N. Tkacheva
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-4193-688X
N.V. Trembach
Kuban State Medical University, Krasnodar, Russia
https://orcid.org/0000-0002-0061-0496
V.E. Khoronenko
P.A. Hertsen Moscow Oncology Research Center, Moscow, Russia
https://orcid.org/0000-0001-8845-9913
M.A. Cherdak
Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
https://orcid.org/0000-0002-9054-0881
#3 2022
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Keywords

elderly and senile patients
perioperative management
anesthesia
senile asthenia
nutritional insufficiency
cognitive impairment

How to Cite

1.
Zabolotskikh I.B., Gorobets E.S., Grigoryev E.V., Kotovskaya Y.V., Lebedinskii K.M., Musaeva T.S., Mkhitaryan E.A., Ovechkin A.M., Ostapenko V.S., Rozanov A.V., Runikhina N.K., Tkacheva O.N., Trembach N.V., Khoronenko V.E., Cherdak M.A. Perioperative management of elderly and senile patients. Recommendations. Annals of Critical Care. 2022;(3):7-26. doi:10.21320/1818-474X-2022-3-7-26
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Abstract

Perioperative management of elderly patients remains one of the most difficult tasks of modern anesthesiology. Compared with younger patients, people over 60 years of age have a higher risk of developing adverse postoperative outcomes, as a result of age-related decline in physiological functions, the presence of several concomitant diseases, polypragmasia, cognitive dysfunction and specific geriatric syndromes, such as frailty. More than 25 % of this category of people have several chronic diseases of the cardiovascular, nervous, endocrine, hematopoietic, musculoskeletal systems, respiratory, digestive and other systems. In the process of aging, there is also a decrease and some perversion of metabolic processes, a decrease in the reactivity of the body. All of the above, along with the surgical intervention, increases the risk of postoperative complications and perioperative mortality.

The recommendations present the definition of the category of elderly and senile patients, provide information about age-related changes in their body that affect anesthesia and intensive care. The main clinical syndromes and symptoms useful in predicting the unfavorable course of the perioperative period are indicated, including frailty, nutritional insufficiency, sarcopenia and cognitive dysfunction. Methods for assessing functional activity and the risk of falls are given separately. Attention is paid to the causes, diagnosis, prevention and treatment of delirium, cardiovascular, respiratory complications. The principles of choosing the method of anesthesia and management of the perioperative period in elderly and senile patients, depending on the features of interventions and concomitant pathology, are described.

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