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2018, Número 4

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Rev Fac Med UNAM 2018; 61 (4)


Valoración preoperatoria del adulto mayor

Herrera-Landero A, d´Hyver DC

Idioma: Español
Referencias bibliográficas: 62
Paginas: 43-55
Archivo PDF: 201.03 Kb.


RESUMEN

El envejecimiento de la población ha generado la necesidad de adecuar la valoración preoperatoria para el grupo de los adultos mayores, ya que además de las alteraciones fisiológicas consecuencia del envejecimiento, se añade la elevada comorbilidad y la presencia de síndromes geriátricos que deben considerarse para la estimación del riesgo quirúrgico, con el objetivo de disminuir complicaciones postoperatorias y favorecer la reintegración a su medio social en el menor tiempo posible y con el mayor grado de independencia.
La valoración preoperatoria identificará en la anamnesis todas las comorbilidades y síndromes geriátricos que pueden impactar en el periodo perioperatorio. Deben solicitarse los estudios de laboratorio y gabinete indispensables para medir la severidad de enfermedades conocidas o establecer un nivel basal prequirúrgico, y de ninguna manera la edad justifica indicar pruebas extensas.
Como en el adulto joven, la enfermedad cardiovascular es la comorbilidad más prevalente y es primordial su adecuada cuantificación. Un punto importante a determinar es el riesgo de desarrollar insuficiencia renal aguda y se debe enfatizar en las medidas preventivas para limitar esta complicación. Una condición asociada a la enfermedad cardiovascular es el uso de antiagregantes plaquetarios o anticoagulantes orales cuyo empleo no debe retrasar los procedimientos quirúrgicos, por lo que su correcto empleo mejorará el desenlace posoperatorio.
Finalmente, el riesgo geriátrico debe orientarse a una adecuada evaluación nutricional para la instauración temprana de alimentación adecuada. Debemos determinar el estado basal de la funcionalidad para el inicio de rehabilitación temprana. La evaluación neuropsicológica debe incluir la identificación de factores de riesgo para delirium, presencia de depresión, deterioro cognitivo y alteraciones en el patrón de sueño. También es primordial identificar al adulto mayor con fragilidad, así como evaluar y limitar la polifarmacia.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Hall MJ, DeFrances CJ, Williams SN, Golosinskiy A, Schwartzman A. National Hospital Discharge Survey: 2007 summary. Natl Health Stat Report. 2010;(29):1-20, 24.

  2. Mangano DT. Perioperative medicine: NHLBI working group deliberations and recommendations. J Cardiothorac Vasc Anesth. 2004;18(1):1-6.

  3. Dewan SK, Zheng SB, Xia SJ. Preoperative geriatric assessment: comprehensive, multidisciplinary and proactive. Eur J Intern Med. 2012;23(6):487-94.

  4. Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215(4):453-66.

  5. Gallardo-Prieto LM, Nellen-Hummel H, Hamui-Sutton A, Castanon-Gonzalez JA, Ibarra-Herrera E, Halabe-Cherem J. [Perioperative evaluation in elderly patients]. Cir Cir. 2006;74(1):59-68.

  6. Boehm O, Baumgarten G, Hoeft A. Preoperative patient assessment: Identifying patients at high risk. Best Pract Res Clin Anaesthesiol. 2016;30(2):131-43.

  7. Nicholas JA. Preoperative optimization and risk assessment. Clin Geriatr Med. 2014;30(2):207-18.

  8. d´Hyver C, Gutiérrez Robledo LM.Geriatría. 3a ed. México: Manual Moderno; 2014.510-21.

  9. Martínez Gallardo Prieto L. El ABC de los síndromes geriátricos y otros temas selectos de la geriatría. 1a ed. México: Editorial Alfil; 2016.203-8.

  10. Woolger JM. Preoperative testing and medication management. Clin Geriatr Med. 2008;24(4):573-83.

  11. Naughton C, Feneck RO. The impact of age on 6-month survival in patients with cardiovascular risk factors undergoing elective non-cardiac surgery. Int J Clin Pract. 2007; 61(5):768-76.

  12. Poldermans D, Bax JJ, Boersma E, De Hert S, Eeckhout E, Fowkes G, et al. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J. 2009;30(22):2769-812.

  13. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery. J Am Coll Cardiol. 2009;54(22):e13-e118.

  14. Cohn SL, Dutta S, Slawski BA, Grant PJ, Smetana GW. Update in perioperative cardiac medicine. Cleve Clin J Med. 2016;83(10):723-30.

  15. Porter CJ, Moppett IK, Juurlink I, Nightingale J, Moran CG, Devonald MA. Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury. BMC Nephrol. 2017 Jan 14;18(1):20. doi: 10.1186/s12882-017-0437-5.

  16. Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Crit Care. 2009; 13(3):R79.

  17. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.

  18. Cartet-Farnier E, Goutelle-Audibert L, Maire P, De la Gastine B, Goutelle S. Implications of using the MDRD or CKD-EPI equation instead of the Cockcroft-Gault equation for estimating renal function and drug dosage adjustment in elderly patients. Fundam Clin Pharmacol. 2017;31(1):110-9.

  19. Izzy M, Malieckal A, Little E, Anand S. Review of efficacy and safety of laxatives use in geriatrics. World J Gastrointest Pharmacol Ther. 2016;7(2):334-42.

  20. Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009;15(4):353-69.

  21. Sheehy AM, Gabbay RA. An overview of preoperative glucose evaluation, management, and perioperative impact. J Diabetes Sci Technol. 2009;3(6):1261-9.

  22. Noordzij PG, Boersma E, Schreiner F, Kertai MD, Feringa HH, Dunkelgrun M, et al. Increased preoperative glucose levels are associated with perioperative mortality in patients undergoing noncardiac, nonvascular surgery. Eur J Endocrinol. 2007;156(1):137-42.

  23. Grossman A, Weiss A, Koren-Morag N, Shimon I, Beloosesky Y, Meyerovitch J. Subclinical Thyroid Disease and Mortality in the Elderly: A Retrospective Cohort Study. Am J Med. 2016;129(4):423-30.

  24. Brunskill SJ, Millette SL, Shokoohi A, Pulford EC, Doree C, Murphy MF, et al. Red blood cell transfusion for people undergoing hip fracture surgery. Cochrane Database Syst Rev. 2015(4):CD009699. doi: 10.1002/14651858. CD009699.pub2.

  25. Cundy J. The perioperative management of patients with polycythaemia. Ann R Coll Surg Engl. 1980;62(6):470-5.

  26. Widimsky P, Motovska Z, Havluj L, Ondrakova M, Bartoska R, Bittner L, et al. Perioperative cardiovascular complications versus perioperative bleeding in consecutive patients with known cardiac disease undergoing non-cardiac surgery. Focus on antithrombotic medication. The PRAGUE-14 registry. Neth Heart J. 2014; 22(9):372-9.

  27. Mattesi L, Noailles T, Rosencher N, Rouvillain JL. Discontinuation of Plavix(R) (clopidogrel) for hip fracture surgery. A systematic review of the literature. Orthop Traumatol Surg Res. 2016;102(8):1097-101.

  28. Faraoni D, Levy JH, Albaladejo P, Samama CM; Groupe d’Intérêt en Hémostase Périopératoire.Updates in the perioperative and emergency management of non-vitamin K antagonist oral anticoagulants.Crit Care. 2015 Apr 29;19:203. doi: 10.1186/s13054-015-0930-9.

  29. Strom C, Rasmussen LS, Steinmetz J. Practical Management of Anaesthesia in the Elderly. Drugs Aging. 2016; 33(11):765-77.

  30. Dripps RD. New classification of physical status. Anesthesiol. 1963;24:111.

  31. Barnett S, Moonesinghe SR. Clinical risk scores to guide perioperative management. Postgrad Med J. 2011;87(1030): 535-41.

  32. Guigoz Y, Vellas B. The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Programme. 1999;1:3-11; discussion -2.

  33. Lopez-Ortega M, Arroyo P. Anthropometric characteristics and body composition in Mexican older adults: age and sex differences. Br J Nutr. 2016;115(3):490-9.

  34. Dupuis M, Kuczewski E, Villeneuve L, Bin-Dorel S, Haine M, Falandry C, et al. Age Nutrition Chirugie (ANC) study: impact of a geriatric intervention on the screening and management of undernutrition in elderly patients operated on for colon cancer, a stepped wedge controlled trial. BMC Geriatr. BMC Geriatr. 2017 Jan 7;17(1):10. doi: 10.1186/ s12877-016-0402-3.

  35. Eschbach D, Kirchbichler T, Wiesmann T, Oberkircher L, Bliemel C, Ruchholtz S, et al. Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study. Clin Interv Aging. 2016;11:1239-46.

  36. Hshieh TT1, Saczynski J, Gou RY, Marcantonio E, Jones RN, Schmitt E, Cooper Z, Ayres D, Wright J, Travison TG, Inouye SK; SAGES Study Group. Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery. Ann Surg. 2017 Apr;265(4):647-53. doi: 10.1097/ SLA.0000000000001952.

  37. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-8.

  38. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001 Dec 5;286(21):2703-10.

  39. Su X, Meng ZT, Wu XH, Cui F, Li HL, Wang DX, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10054):1893-902.

  40. Bagri AS, Rico A, Ruiz JG. Evaluation and management of the elderly patient at risk for postoperative delirium. Clin Geriatr Med. 2008;24(4):667-86, viii.

  41. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37-49.

  42. Baker FM, Espino DV. A Spanish version of the geriatric depression scale in Mexican-American elders. Int J Geriatr Psychiatry. 1997;12(1):21-5.

  43. Aguilar-Navarro SG, Fuentes-Cantu A, Avila-Funes JA, Garcia-Mayo EJ. [Validity and reliability of the screening questionnaire for geriatric depression used in the Mexican Health and Age Study]. Salud Publica Mex. 2007;49(4): 256-62.

  44. Arevalo-Rodriguez I, Smailagic N, Roque IFM, Ciapponi A, Sanchez-Perez E, Giannakou A, et al. Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2015(3): CD010783.

  45. Fage BA, Chan CC, Gill SS, Noel-Storr AH, Herrmann N, Smailagic N, et al. Mini-Cog for the diagnosis of Alzheimer’s disease dementia and other dementias within a community setting. Cochrane Database Syst Rev. 2015(2): CD010860.

  46. Ozer S, Young J, Champ C, Burke M. A systematic review of the diagnostic test accuracy of brief cognitive tests to detect amnestic mild cognitive impairment. Int J Geriatr Psychiatry. 2016;31(11):1139-50.

  47. Screening for dementia: recommendations and rationale. Am J Nurs. Am J Nurs. 2003 Sep;103(9):87, 89, 91, 93, 95.

  48. Lin JS, O’Connor E, Rossom RC, Perdue LA, Eckstrom E. Screening for cognitive impairment in older adults: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;159(9):601-12.

  49. Nguyen TN, Cumming RG, Hilmer SN. A Review of Frailty in Developing Countries. J Nutr Health Aging. 2015;19(9):941-6.

  50. He W, Muenchrath MN, Kowal P. Shades of Gray: A Cross-Country Study of Health and Well-Being of the Older Populations in SAGE Countries, 2007-2010. Washington, DC: U.S. Government Printing Office; 2012.

  51. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.

  52. McIsaac DI, Taljaard M, Bryson GL, Beaule PE, Gagne S, Hamilton G, et al. Comparative assessment of two frailty instruments for risk-stratification in elderly surgical patients: study protocol for a prospective cohort study. BMC Anesthesiol. 2016 Nov 14;16(1):111.

  53. Fagard K, Leonard S, Deschodt M, Devriendt E, Wolthuis A, Prenen H, et al. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review. J Geriatr Oncol. 2016;7(6):479-91.

  54. Hall DE, Arya S, Schmid KK, Carlson MA, Lavedan P, Bailey TL, et al. Association of a Frailty Screening Initiative With Postoperative Survival at 30, 180, and 365 Days. JAMA Surg. 2017 Mar 1;152(3):233-240. doi: 10.1001/ jamasurg.2016.4219.

  55. Robinson TN, Eiseman B, Wallace JI, Church SD, McFann KK, Pfister SM, et al. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg. 2009;250(3):449-55.

  56. Barnett SR. Polypharmacy and perioperative medications in the elderly. Anesthesiol Clin. 2009;27(3):377-89

  57. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227-46.

  58. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2):72-83.

  59. Brown JD, Hutchison LC, Li C, Painter JT, Martin BC. Predictive Validity of the Beers and Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions (STOPP) Criteria to Detect Adverse Drug Events, Hospitalizations, and Emergency Department Visits in the United States. J Am Geriatr Soc. 2016;64(1):22-30.

  60. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977;297(16):845-50.

  61. Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, et al. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med. 1986;1(4):211-9.

  62. Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med. 1986;146(11):2131-4.




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