Präoperative Dauertherapie

[Anesthesiological care of trauma patients in orthogeriatric co-management]

Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient.

[Anesthesiological care in orthogeriatric co-management. Perioperative treatment of geriatric trauma patients]

Elderly patients increasingly need to undergo surgery under anesthesia, especially following trauma. A timely interdisciplinary approach to the perioperative management of these patients is decisive for the long-term outcome. Orthogeriatric co-management, which includes geriatricians and anesthesiologists from an early stage, is of great benefit for geriatric patients. Patient age, comorbidities and self-sufficiency in activities of daily life are decisive for an anesthesiological assessment of the state of health and preoperative risk stratification. If necessary additional investigations, such as echocardiography must be carried out, in order to guarantee optimal perioperative anesthesiological management. Certain medical factors can delay the initiation of anesthesia and it is absolutely necessary that these are taken into consideration for surgical management. Not every form of anesthesia is equally suitable for every geriatric patient.

[Minimizing perioperative risk - an interdisciplinary effort]

Physicians involved in perioperative care have to face new challenges because of the continuing aging of the population and medical progress, which facilitates even more invasive surgery. The risk of surgical procedures is elevated in patients with cardiac co-morbidity necessitating an optimization of both clinical condition and preoperative therapy of these patients. Innovative therapeutic concepts like fast-track surgery, new approaches in coronary revascularisation, and new strategies of anticoagulation require an interdisciplinary treatment of these patients and a strict collaboration of surgeons and anaesthesiologists with the colleagues from other nonsurgical disciplines like internal medicine and cardiology. Physicians should start beforehand the interdisciplinary preparation of surgical patients as out-patients and should continue this approach during the stay in hospital. In this review, we describe the major perioperative cardiac, pulmonary and vascular risks for physicians involved in the treatment of surgical patients.