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Anaesthesia for Geriatricians Richard Griffiths MD FRCA Peterborough & Stamford Hospitals NHS Trust
Anaesthesia for Geriatricians
Richard Griffiths MD FRCA
Peterborough & Stamford Hospitals NHS Trust
Talk Outline
1. Types of anaesthesia
2. Risk Assessment
3. Elective v Emergency
4. Wish list for future training
Anaesthesia
When ever a surgical procedure is planned always ask the following;
Can it be performed with;
1. General anaesthesia
2. Regional anaesthesia
3. Local anaesthesia
Pharmacology
Intravenous agents
Volatile agents
Local anaesthetics (used locally, regionally or intravenously)
Opioids
Adjuvants (ketamine, NSAIDs, paracetamol)
DELIRIUM
Clinical Example
Ankle fracture in 85 year old female
Could do
GA
Spinal anaesthesia (regional)
Local blocks? A possibility if patient is particularly unwell
COLORECTAL
Analgesia
Risk Assessment
Must be performed for all elective cases
Should be performed for all emergency cases
What tools are available?
Risk Assessment- ASA Classification
First described in 1940-41, first example of risk stratification
Modified in 1963
There are 5 classes, E means emergency
Arabic numerals, not Roman (original paper 1941)
ASA Classification
Must be recorded for all cases
Often dispute about grades
Obesity, smoking cause controversy
Used in many national registries, NHFD, NJR
Elective Surgery
Risk Assessment
Donati et al BJA 2004
National Surgical Quality Improvement Programme Calculator
Free
NSQIP Calculator
http://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp
Emergency
Elective Cases chance to get patient in the best possible condition for surgery and the recovery period
EMERGENCY may have only a matter of minutes to “optimise” the patient
NCEPOD
RISK ASSESSMENT
Very important in emergency cases
Surgical outcome risk tool (SORT) (NCEPOD)
Nottingham Hip Fracture Score (NHFS)
Both available on app store
Also
Cardiff Surgical Risk Score (Possum based)
RISK ASSESSMENT
Emergency Cases
National Emergency Laparotomy Audit (NELA)
Availability of HDU/ITU post operatively
NB P-Possum tends to over estimate mortality at higher levels
http://www.riskprediction.org.uk/index-pp.php
Regional V General Debate
Endless arguments
No evidence that general is better
Little evidence that regional is better
Lots of evidence that regional causes less harm
Wish List
Hip Fracture Anaesthesia Fellowships
Geriatricians spending time in theatre, HDU/ITU, post anaesthesia care units
Anaesthetists (with an interest) spending time on wards, clinics, community
