Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Drugs & Aging
Published in: Drugs & Aging 4/2010

01-04-2010 | Therapy In Practice

General Anaesthesia in Elderly Patients with Cardiovascular Disorders

Choice of Anaesthetic Agent

Authors: Sangeeta Das, Dr Kirsty Forrest, Simon Howell

Published in: Drugs & Aging | Issue 4/2010

Login to get access

Abstract

Our population is aging; currently 15% of the Western population are aged >65 years, and represent 25% of those undergoing surgery. The proportion of the population aged ≥65 years is rapidly growing, and an increasing number are affected with cardiovascular disease.
The older person is a high-risk patient. This is because of their altered physiology and associated co-morbidities, as well as the pharmacokinetic and pharmacodynamic changes that may alter drug responses. There is considerable variability seen in the physical and physiological states of individual patients within the older population. This has an important impact on choosing a safe anaesthetic technique for each individual, which in turn can influence the morbidity and mortality in this population.
The physiological changes in the aging cardiovascular system affect the arterial and venous vasculature, myocardium and autonomic nervous system, making the older person more prone to cardiovascular instability. In addition to the physiological changes, the cardiovascular status of the older person tends to be compromised by associated pathological conditions that are more common with increasing age. Pharmacokinetic and pharmacodynamic changes must be taken into account when deciding about drug dosing in this age group. Aspects of dose reduction, titration of drugs, dosing intervals and the pharmacodynamic effects of each class of drug are explained in detail in the text.
The major challenge in anaesthesia for the older person with cardiovascular disease is maintenance of haemodynamic stability, particularly in the face of reduced physiological reserve and capability to respond to periods of instability. An appropriate anaesthetic technique must be selected to minimize haemodynamic changes and maintain near normal physiological status. The other key objective is to minimize the incidence of adverse outcomes, such as perioperative myocardial ischaemia/infarction, arrhythmias, heart failure, postoperative cognitive dysfunction and stroke. No single anaesthetic regimen or agent can be advocated. Knowledge of the pharmacokinetic and pharmacodynamic principles of anaesthetic agents and their altered response in elderly patients is essential when selecting an anaesthetic agent.
This article provides a practical guide to the selection and use of general anaesthetic agents in older patients with cardiovascular disorders, highlighting the differences among various agents.
Literature
1.
2.
Friedl LP, Kronmal RA, Newman AB, et al. Risk factors for five year mortality in older adults: the Cardiovascular Health Study. JAMA 1998; 279: 585–92CrossRef
3.
4.
Shipton EA. The perioperative care of the geriatric patient. S Afr Med J 1983; 63: 855–60PubMed
5.
6.
Rooke GA. Cardiovascular ageing and anesthetic implications. J Cardiothorac Vasc Anesth 2003; 17(4): 512–23PubMedCrossRef
7.
Lichtor JL. Sponsored research reveals postoperative mortality stats. Anesth Patient Saf Found Newsl 1988; 3: 9–11
8.
Khuri SF, Daley J, Henderson W, et al. Risk adjustment of postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185: 315–27PubMed
9.
Groenink M, Langerak SE, Vanbavel E, et al. The influence of ageing and aortic stiffness on permanent dilation and breaking stress of the thoracic descending aorta. Cardiovasc Res 1999; 43: 471–80PubMedCrossRef
10.
Lakatta E. Ageing effects on the vasculature in health: risk factors for cardiovascular disease. Am J Geriatr Cardiol 1994; 3: 11–7PubMed
11.
Lakatta EG. Cardiovascular ageing research: the next horizons. J Am Geriatr Soc 1999; 47: 613–25PubMed
12.
Bulpitt CJ, Rajkumar C, Cameron JD. Vascular compliance as a measure of biological age. J Am Geriatr Soc 1999; 47: 657–63PubMed
13.
Yin FCP, Ting CT. Compliance changes in physiological and pathological states. J Hypertension 1992; 10 Suppl.: 31–3CrossRef
14.
Downes TR, Nomeir AB, Smith KM, et al. Mechanism of altered pattern of left ventricular filling with ageing in subjects without cardiac disease. Am J Cardiol 1989; 64: 523–7PubMedCrossRef
15.
Ebert TJ, Morgan BJ, Barney JA, et al. Effects of ageing on baroreflex regulation of sympathetic activity in humans. Am J Physiol 1992; 263: H798–803PubMed
16.
Lakatta EG. Alteration in the cardiovascular system that occur in advanced age. Fed Proc 1979; 38: 13–167
17.
Fagard R, Thijs L, Amery A. Age and the hemodynamic response to posture and to exercise. Am J Geriatr Cardiol 1993; 2: 23–40PubMed
18.
Gribbin B, Pickering TG, Sleight P, et al. Effect of age and high blood pressure on baroreflex sensitivity in man. Circ Res 1971; 29: 424–31PubMedCrossRef
19.
Critchley LAH, Conway F. Hypotension during subarachnoid anaesthesia: haemodynamic effects of colloid and metaraminol. Br J Anaesth 1996; 76: 734–6PubMedCrossRef
20.
Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. Executive summary: report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 2007; 50: 1707–32PubMedCrossRef
21.
Shah KB, Kleinman BS, Sami H, et al. Re-evaluation of perioperative myocardial infarction in patients with prior myocardial infarction undergoing noncardiac operations. Anesth Analg 1990; 71: 231–5PubMedCrossRef
22.
Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–50PubMedCrossRef
23.
Howell SJ, Sear YM, Sear JW, et al. Cardiovascular death within 30 days following anaesthesia and urgent or emergency surgery: determination of risk factors using a nested case control study. Br J Anaesth 1999; 82: 679–84PubMedCrossRef
24.
Levine WC, Mehta V, Landesberg G, et al. Anaesthesia for elderly: selected topics. Curr Opin Anaesthesiol 2006; 19: 320–4PubMedCrossRef
25.
26.
Howell SJ, Sear JW, Foex P. Hypertension, hypertensive heart disease and perioperative cardiac risk. Br J Anaesth 2004; 92(4): 570–83PubMedCrossRef
27.
Franklin SS, Khan SA, Wong ND, et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation 1999; 100: 354–60PubMedCrossRef
28.
Williams B, Poulter NR, Brown MJ, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV). BMJ 2004; 328: 634–40PubMedCrossRef
29.
Aronson S, Boisvert D, Lapp W. Isolated systolic hypertension is associated with adverse outcomes from coronary artery bypass grafting surgery. Anesth Analg 2002; 94: 1079–84PubMedCrossRef
30.
31.
Christ M, Sharkova Y, Geldner G, et al. Preoperative and perioperative care for patients with suspected or established aortic stenosis facing noncardiac surgery. Chest 2005; 128: 2944–53PubMedCrossRef
32.
Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease: Cardiovascular Health Study. J Am Coll Cardiol 1997; 29: 630–4PubMedCrossRef
33.
Lindroos M, Kupari M, Heikkila J, et al. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993; 21: 1220–5PubMedCrossRef
34.
Lombard JT, Selzer A. Valvular aortic stenosis: a clinical and hemodynamic profile of patients. Ann Intern Med 1987; 106: 292–8PubMed
35.
Eagle KA, Berger PB, Calkins H, et al. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery. Executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg 2002; 94: 1052–64PubMedCrossRef
36.
Cooper N, Forrest K, Mulley G, editors. ABC of geriatric medicine. Oxford: Wiley-Blackwell, 2009 Jan
37.
Comfere T, Sprung J, Kumar MM, et al. Angiotensin system inhibitors in a general surgical population. Anesth Analg 2005; 100: 636–44PubMedCrossRef
38.
Mangano DT, Layug EL, Wallace A, et al. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery: Multicenter Study of Perioperative Ischemia Research Group. N Engl J Med 1996; 335: 1713–20PubMedCrossRef
39.
Poldermans D, Boersma E, Bax JJ, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery: Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med 1999; 341: 1789–94PubMedCrossRef
40.
POISE study group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 2008; 371: 1839–47CrossRef
41.
Poldermans D, Schouten O, Van Lier F, et al. Perioperative strokes and β-blockade. Anesthesiology 2009; 111: 940–5PubMedCrossRef
42.
Hayashi Y, Sumikawa K, Kuro M, et al. Rolls of beta 1 and beta 2 adrenoceptors in the mechanism of halothane myocardial sensitization in dogs. Anesth Analg 1991; 72(4): 435–9PubMedCrossRef
43.
Wood M. Pharmacokinetic drug interactions in anaesthetic practice. Clin Pharmacokinet 1991; 21(4): 285–304PubMedCrossRef
44.
Wali FA. Interaction of verapamil with gallamine and pancuronium and reversal of combined neuromuscular blockade with neostigmine and edrophonium. Eur J Anaesthesiol 1986; 3(5): 385–93PubMed
45.
Dec GW. Digoxin remains useful in the treatment of chronic heart failure. Med Clin North Am 2003; 87(2): 317–37PubMedCrossRef
46.
Bartolone RS, Rao TL. Dysrhythmias following muscle relaxant administration in patients receiving digitalis. Anesthesiology 1983; 58(6): 567–9PubMedCrossRef
47.
Stoelting RK. Pharmacology and physiology in anesthetic practice. 3rd ed. Philadelphia (PA): Lippincott-Raven, 1999
48.
Silverstein JH, Rooke GA, Reves JG, et al. Geriatric anaesthesiology. 2nd ed. New York: Springer Science and Business Media, 2008CrossRef
49.
Martin G, Glass PS, Breslin DS, et al. A study of anesthetic drug utilisation in different age groups. J Clin Anesth 2003; 15(3); 194–200PubMedCrossRef
50.
Kirkbride DA, Parker JL, Williams GD, et al. Induction of anesthesia in the elderly ambulatory patients: a double blinded comparison of propofol and sevoflurane. Anesth Analg 2001; 93(5): 1185–7PubMedCrossRef
51.
John AD, Sieber FE. Age associated issues: geriatrics. Anesthesiol Clin North Am 2004; 22(1): 45–58CrossRef
52.
Shafer SL. The pharmacology of anaesthetic drugs in elderly patients. Anesthesiol Clin North Am 2000; 18(1): 1–29CrossRef
53.
Scheepstra GL, Booij LH, Rutten CL, et al. Propofol for induction and maintenance of anaesthesia: comparison between older and younger patients. Br J Anaesth 1989; 62: 54–60PubMedCrossRef
54.
Kazama T, Ikeda K, Morita K, et al. Comparison of the effect site k(e0)s of propofol for blood pressure and EEG by spectral index in elderly and younger patients. Anesthesiology 1999; 90(6): 1517–27PubMedCrossRef
55.
Schuttler J, Ihmsen H. Population pharmacokinetics of propofol: a multicenter study. Anesthesiology 2000; 92: 727–38PubMedCrossRef
56.
Schnider TW, Minto CF, Gumbus PL, et al. The influence of method of administration and covariates on the pharmacokinetics of propofol in adult volunteers. Anesthesiology 1998; 88(5): 1170–82PubMedCrossRef
57.
Schnider TW, Minto CF, Shafer SL, et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999; 90: 1502–16PubMedCrossRef
58.
Russo H, Bressolle E. Pharmacokinetics and pharmacodynamics of thiopental. Clin Pharmacokinet 1998; 35: 95–134PubMedCrossRef
59.
Ball C, Westhorpe R. The history of intravenous anaesthesia: the barbiturates. Part 1. Anaesth Intensive Care 2001; 29(2): 97
60.
Ball C, Westhorpe R. The history of intravenous anaesthesia: the barbiturates. Part 2. Anaesth Intensive Care 2001; 29(3): 219
61.
Ball C, Westhorpe R. The history of intravenous anaesthesia: the barbiturates. Part 3. Anaesth Intensive Care 2001; 29(4): 323
62.
63.
Sonntag H, Hellberg K, Schenk HD, et al. Effects of thiopental (Trapanal) on coronary blood flow and myocardial metabolism in man. Acta Anesthesiol Scand 1975; 19(1): 69–78CrossRef
64.
Homer TD, Stanski DR. The effect of increasing age on thiopental disposition and anesthetic requirement. Anesthesiology 1985; 62: 714–24PubMedCrossRef
65.
Stanski DR, Maitre PO. Population pharmacokinetics and pharmacodynamics of thiopental: the effect of age revisited. Anesthesiology 1990; 72: 412–22PubMedCrossRef
66.
Dundee JW, Halliday NJ, Loughran PG, et al. The influence of age on the onset of anaesthesia with midazolam. Anaesthesia 1985; 40: 441–3PubMedCrossRef
67.
White PF, Negus JB. Sedative infusions during local and regional anesthesia: a comparison of midazolam and propofol. J Clin Anesth 1991; 3(1): 32–9PubMedCrossRef
68.
Sunzel M, Pallzow L, Berggren L, et al. Respiratory and cardiovascular effects in relation to plasma levels of midazolam and diazepam. Br J Clin Pharmacol 1988; 25: 561–9PubMedCrossRef
69.
Samuelson PN, Reves JG, Kouchoukos NT, et al. Hemodynamic responses to anesthetic induction with midazolam or diazepam in patients with ischemic disease. Anesth Analg 1981; 60: 802–9PubMedCrossRef
70.
Rouff R, Reves JG. Hemodynamic effects of lorazepam-fentanyl anesthetic induction for coronary artery bypass surgery. J Cardiothorac Anesth 1990; 4: 314–7CrossRef
71.
Heikkilä H, Jalonen J, Arola M, et al. Midazolam as adjunct to high-dose fentanyl anesthesia for coronary artery bypass graft operation. Acta Anaesthesiol Scand 1984; 28: 683–9PubMedCrossRef
72.
Benson KT, Tomlinson DL, Goto H, et al. Cardiovascular effects of lorazepam during sufentanil anesthesia. Anesth Analg 1988; 67: 966–8CrossRef
73.
Windsor JW, Sherry K, Feneck RO, et al. Sufentanil and nitrous oxide anesthesia for cardiac surgery. Br J Anaesth 1988; 61: 662–8PubMedCrossRef
74.
Maitre PO, Buhrer M, Thomson D, et al. A three-step approach combining Bayesian regression and NONMEM population analysis: application to midazolam. J Pharmacokinet Biopharm 1991; 19: 377–84PubMed
75.
Reves JG, Fragen RJ, Vinik HR, et al. Midazolam: pharmacology and uses. Anesthesiology 1985; 62: 310–24PubMedCrossRef
76.
Allolio B, Dorr H, Stuttmann R, et al. Effect of a single bolus dose of etomidate upon eight major corticosteroid hormones and plasma ACTH. Clin Endocrinol (Oxf) 1985; 22: 281–6CrossRef
77.
Holdcroft A, Morgan M, Whitwam JG, et al. Effect of dose and premedication on induction complications with etomidate. Br J Anaesth 1976; 48: 199–205PubMedCrossRef
78.
Kettler D, Sonnata H, Donath U, et al. Haemodynamics, myocardial mechanics, oxygen requirement and oxygenation of the human heart during induction of anaesthesia with etomidate [in German]. Anaesthesist 1974; 23: 116–21PubMed
79.
Arden JR, Holley OF, Stanski DR. Increased sensitivity to etomidate in the elderly: initial distribution versus altered brain response. Anesthesiology 1986; 65: 19–27PubMedCrossRef
80.
Calvey TN, Williams NE. Principles and practice of pharmacology for anaesthetists. 4th ed. Oxford: Blackwell Scientific Publications, 2001
81.
Jolly AS, Jain P, Sood J. Ketamine: current uses and future perspectives. J Anaesthesiol Clin Pharmacol 2007; 23(2): 169–81
82.
Granry JC, Dube L, Turroques H, et al. Ketamine: new uses for an old drug. Curr Opin Anaesthesiol 2000; 13(3): 299–302PubMedCrossRef
83.
Finlay I. Ketamine and its role in cancer pain. Pain Rev 1999; 6(4): 303–13CrossRef
84.
Maneglia R, Cousin MT. A comparison between propofol and ketamine for anaesthesia in the elderly: haemodynamic effects during induction and maintenance. Anaesthesia 1988; 43 Suppl.: 109–11PubMedCrossRef
85.
Zickmann B, Kling D, Quis S. S-(+)-ketamine versus ketamine racemic mixture: hemodynamic studies. Anasthesiol Intensivmed Notfallmed Schmerzther 2000; 35(5): 333–9PubMedCrossRef
86.
Adams HA. S-(+)-ketamine: cardiovascular interactions during total intravenous anaesthesia and analgosedation. Anaesthesist 1997; 46(12): 1081–7PubMedCrossRef
87.
Pai A, Heining M. Ketamine. Cont Educ Anaesth Crit Care Pain (CEACCP) 2007; 7: 59–63CrossRef
88.
Miller RD. Miller’s anesthesia. 7th ed. Edinburgh: Elsevier Churchill Livingstone, 2009
89.
Hudetz JA, Iqbal Z, Gandhi SD, et al. Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery. Acta Anaesthesiol Scand 2009; 53(7): 864–72PubMedCrossRef
90.
Himmelseher S, Pfenninger E. The clinical use of S-(+)-ketamine: a determination of its place. Anasthesiol Intensivmed Notfallmed Schmerzther 1998; 33(12): 764–70PubMedCrossRef
91.
Houltz E, Caidahl K, Adin C, et al. Effects of halo thane and isoflurane on left ventricular diastolic function during surgical stress in patients with coronary artery disease. Acta Anaesthesiol Scand 1996; 41: 931–8CrossRef
92.
McKinney MS, Fee JP, Clarke RS. Cardiovascular effects of isoflurane and halothane in young and elderly patients. Br J Anaesth 1993; 71: 696–701PubMedCrossRef
93.
Malan TP, Dinardo JA, Isner RJ, et al. Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers. Anesthesiology 1995; 83: 918–28PubMedCrossRef
94.
Yamaguchi S, Ikeda T, Wake K, et al. A sevoflurane induction of anaesthesia with gradual reduction of concentration is well tolerated in elderly patients. Can J Anesth 2003; 50: 26–31PubMedCrossRef
95.
Weiskopef RB, Moore MA, Eger II EI, et al. Rapid increase in desflurane concentration is associated with greater transient cardiovascular stimulation than with rapid increase in isoflurane concentration in humans. Anesthesiology 1994; 80: 1035–45CrossRef
96.
97.
Cepeda MS, Farrar JT, Baumgarten M, et al. Side effects of opioids during short term administration: effect of age, gender and race. Clin Pharmacol Ther 2003; 74: 102–12PubMedCrossRef
98.
Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology 1999; 91: 109–18PubMedCrossRef
99.
Portenoy RK, Foley KM, Stulman J, et al. Plasma morphine and morphine-6-glucuronide during chronic morphine therapy for cancer pain: plasma profiles, steady state concentrations and the consequences of renal failure. Pain 1991; 47: 13–9PubMedCrossRef
100.
Lotsch J, Skarke C, Schmidt H, et al. The transfer half life of morphine-6-glucuronide from plasma to effect site assessed by pupil size measurement in healthy volunteers. Anesthesiology 2001; 95: 1329–38PubMedCrossRef
101.
Skarke C, Jarrar M, Erb K, et al. Respiratory and miotic effects of morphine in healthy volunteers when P-glycoprotein is blocked by quinidine. Clin Pharmacol Ther 2003; 74: 303–11PubMedCrossRef
102.
Skarke C, Darimont J, Schmidt H, et al. Analgesic effects of morphine and morphine-6-glucuronide in a transcutaneous electrical pain model in healthy volunteers. Clin Pharmacol Ther 2003; 73: 107–21PubMedCrossRef
103.
Aubrun F, Monsel S, Langeron O, et al. Post operative titration of intravenous morphine in the elderly patient. Anesthesiology 2002; 96: 17–23PubMedCrossRef
104.
Auburn F, Bunge D, Langeron O, et al. Postoperative morphine consumption in the elderly patient. Anesthesiology 2003; 99: 160–5CrossRef
105.
Homburger JA, Meiler SE. Anesthesia drugs, immunity and long term outcome. Curr Opin Anaesthesiol 2006; 19(4): 423–8PubMedCrossRef
106.
107.
Scott JC, Stanski DR. Decreased fentanyl/alfentanil dose requirement with increasing age: a pharmacodynamic basis. J Pharmacol Exp Ther 1987; 240: 159–66PubMed
108.
Scott JC, Ponganis KV, Stanski DR. EEG quantitation of narcotic effect: the comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 1985; 62: 234–41PubMedCrossRef
109.
Minto CF, Schnider TW, Shafer SL. The influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. II: model application. Anesthesiology 1997; 86: 24–33PubMedCrossRef
110.
Duvaldestin P, Saada J, Berger JL, et al. Pharmacokinetics, pharmacodynamics and dose-response relationships of pancuronium in control and elderly subjects. Anesthesiology 1982; 56: 36–40PubMedCrossRef
111.
Edward Morgan G. Clinical anesthesiology. 3rd ed. New York: Lange Medical Books/Mcgraw-Hill Medical Publishing, 2002
112.
Kitts JB, Fisher DM, Canfell PC, et al. Pharmacokinetics and pharmacodynamics of atracurium in the elderly. Anesthesiology 1990; 72: 272–5PubMedCrossRef
113.
Parker CJ, Hunter JM, Snowdon SL. Effect of age, gender and anaesthetic technique on the pharmacodynamics of atracurium. Br J Anaesth 1993; 70: 38–41PubMedCrossRef
114.
Rupp SM, Castagnoli KP, Fisher DM, et al. Pancuronium and vecuronium pharmacokinetics and pharmacodynamics in younger and elderly adults. Anesthesiology 1987; 67: 45–9PubMedCrossRef
115.
d’Hollander AA, Massaux F, Nevelsteen M, et al. Age dependent dose-response relationship of ORG NC45 in anaesthetised patients. Br J Anaesth 1982; 54: 653–6PubMedCrossRef
116.
117.
Baykara N, Solak M, Toker K. Predicting recovery from deep neuromuscular block by rocuronium in the elderly. J Clin Anesth 2003; 15: 328–33PubMedCrossRef
118.
Bevan DR, Fiset P, Balendran P, et al. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anesth 1993; 40: 127–32PubMedCrossRef
119.
Matteo RS, Ornstein E, Schwartz AE, et al. Pharmacokinetics and pharmacodynamics of rocuronium in elderly surgical patients. Anesth Analg 1993; 77: 1193–7PubMedCrossRef
120.
Shorten GD, Uppington J, Comunale ME. Changes in plasma catecholamine concentrations and haemodynamic effects of rocuronium and vecuronium in elderly patients. Eur J Anaesthesiol 1998; 15(3): 335–41PubMed
121.
Cope TM, Hunter JM. Selecting neuromuscular-blocking drugs for elderly patients. Drugs Aging 2003; 20(2): 125–40PubMedCrossRef
122.
Maddineni VR, Mirakhur RK, McCoy EP. Plasma cholinesterase activity in elderly and young adults [letter]. Br J Anaesth 1994; 72: 497PubMedCrossRef
123.
Viby-Mogensen J. Correlation of succinylcholine duration of action with plasma cholinesterase activity in subjects with the genotypically normal enzyme. Anesthesiology 1980; 53: 517–20PubMedCrossRef
124.
125.
Koscielniak-Nielsen ZJ, Law-Min JC, Donati F, et al. Dose-response relations of doxacurim and its reversal with neostigmine in young adults and healthy elderly patients. Anaesth Analg 1992; 74: 845–50CrossRef
126.
Young WL, Matteo RS, Ornstein E. Duration of action of neostigmine and pyridostigmine in the elderly. Anesth Analg 1988; 67: 775–8PubMed
127.
Young WL, Backus W, Matteo RS, et al. Pharmacokinetics and pharmacodynamics of neostigmine in the elderly [abstract]. Anesthesiology 1984; 61: A300CrossRef
128.
Muravchick S, Owens WD, Felts JA. Glycopyrrolate and cardiac dysrhythmias in geriatric patients after reversal of neuromuscular blockade. Can Anaesth Soc J 1979; 26: 22–5PubMedCrossRef
129.
130.
Yang LP, Keam SJ. Sugammadex: a review of its use in anaesthetic practice. Drugs 2009; 69(7): 919–42PubMedCrossRef
131.
Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesthesia Analg 2007; 104(3): 575–81CrossRef
132.
Poldermans D, Jeroen JB, Boersma E, et al. Task Force of European Society of Cardiology (endorsed by the European Society of Anaesthesiology). Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 2009; 30: 2769–812PubMedCrossRef
Metadata
Title
General Anaesthesia in Elderly Patients with Cardiovascular Disorders
Choice of Anaesthetic Agent
Authors
Sangeeta Das
Dr Kirsty Forrest
Simon Howell
Publication date
01-04-2010
Publisher
Springer International Publishing
Published in
Drugs & Aging / Issue 4/2010
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI
https://doi.org/10.2165/11534990-000000000-00000

Other articles of this Issue 4/2010

Drugs & Aging 4/2010 Go to the issue

Review Article

Assessment and Management of Pressure Ulcers in the Elderly

Review Article

Multiple Sclerosis in the Elderly Patient

Review Article

Use of Hydromorphone, with Particular Reference to the OROS® Formulation, in the Elderly

Review Article

Clinical Review and Treatment of Select Adverse Effects of Dopamine Receptor Agonists in Parkinson’s Disease

Original Research Article

Validity of the Finnish Prescription Register for Measuring Psychotropic Drug Exposures among Elderly Finns
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits