Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology

O sistema respiratório e o idoso: implicações anestésicas

The respiratory system and the elderly: anesthetic implications

Cláudia Regina Fernandes; Pedro Poso Ruiz Neto

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JUSTIFICATIVA E OBJETIVOS: As complicações respiratórias são responsáveis por grande parte dos óbitos após procedimentos cirúrgicos que ocorrem na população geriátrica. O envelhecimento causa importante diminuição da reserva funcional do sistema respiratório, e um número crescente de pacientes idosos está sendo submetido a procedimentos cada vez mais complexos. O objetivo deste trabalho é revisar o sistema respiratório durante o processo de envelhecimento, as alterações causadas pela anestesia no idoso, enfatizando a avaliação pré-operatória da função respiratória, complicações pulmonares pós-operatórias e detalhes do manuseio anestésico. CONTEÚDO: São apresentadas as alterações respiratórias fisiológicas do envelhecimento. São enfatizadas as alterações de volume e capacidades pulmonares, da mecânica respiratória e de trocas gasosas proporcionadas pela anestesia. São abordados aspectos relativos à morbimortalidade pulmonar pós-operatória em geriatria, destacando-se a importância da adequada avaliação pré-operatória, considerando-se desde testes de esforço até testes específicos que quantificam a reserva funcional pulmonar. São discutidas técnicas anestésicas apropriadas em idosos. CONCLUSÕES: O envelhecimento é acompanhado de alterações no sistema respiratório. Evidências demonstram que mesmo na ausência de pneumopatia, a idade avançada constitui fator de risco para complicações pulmonares no pós-operatório. Deve haver preocupação com adequada avaliação pré-operatória da função respiratória, apropriado manuseio anestésico e cuidados pós-operatórios específicos.




BACKGROUND AND OBJECTIVES: Respiratory complications are responsible for a major number of elderly deaths after surgical procedures. Aging entails an important decrease in respiratory system functional reserves, while an increasing number of elderly people are being submitted to increasingly complex procedures. This study is a review of the respiratory system during aging and of anesthesia-induced changes in the elderly, emphasizing preoperative evaluation of respiratory function, postoperative pulmonary complications and details of anesthetic management. CONTENTS: Physiologic respiratory changes due to aging are presented, with emphasis in pulmonary volume and capacity abnormalities, respiratory mechanics and gas exchange provided by anesthesia. Perioperative pulmonary mortality and morbidity in elderly patients are addressed, emphasizing the importance of appropriate preoperative evaluation, from stress tests to specific tests, to quantify pulmonary functional reserves. Appropriate anesthetic techniques for the elderly are discussed. CONCLUSIONS: Aging brings about several respiratory system changes. Evidences have shown that, even in the absence of pulmonary disease, advanced age is a risk factor for postoperative pulmonary complications. It is necessary a thorough evaluation of preoperative respiratory function, adequate anesthetic management and specific postoperative care.




Djokovic Jl, Hedley-Whyte J. Prediction of outcome of surgery and anesthesia in patients over 80. JAMA. 1979:242.

Mohr DN. Estimation of surgical risk in the elderly: a correlative review. J Am Geriatr Soc. 1983;31:99-102.

Zaugg M, Lucchinetti E. Respiratory function in the elderly. Anesth Clin North America. 2000;18:47-58.

Muller N, Volgyesi G, Becker L. Diaphragmatic muscle tone. J Appl Physiol. 1979;47:279-284.

Froese AB, Bryan AC. Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology. 1979;41:242-255.

Don H. The mechanical properties of the respiratory system during anesthesia. Int Anesth Clin. 1977;15:113-136.

Rehder K, Sessler AD, Marsh HM. General anesthesia and the lung. Am Rev Respir Dis. 1975;112:541-563.

Dueck R. Gas exchange. Int Anesth Clin. 1984;22:13-28.

Wahba WM. Influence of aging on lung function: Clinical significance of changes from ages twenty. Anesth Analg. 1983;62:764-776.

Sykes MK, Lohn L, Seed RF. The effect of inhalational anaesthetics on hypoxic pulmonary vasoconstriction and pulmonary vascular resistance in the perfused lung of the dog and cat. Br J Anaesth. 1972;44:776-788.

Isawa T, Teshima T, Hirano T. Regulation of regional perfusion distribution in the lungs: effect of regional oxygen concentration. Am Rev Respir Dis. 1978;118:55-56.

Fletcher R. Smoking, age, and the arterial-end-tidal PCO2 difference during anaesthesia and controlled ventilation. Acta Anaesthesiol Scand. 1987;31:355-356.

Garibaldi RA, Britt MR, Coleman ML. Risk factors for postoperative pneumonia. Am J Med. 1981;70:677-680.

McPeek B, Gasko M, Mosteller F. Measuring outcome from anesthesia and operation. Theor Surg. 1986;1:2-9.

Pflug AE, Murphy TM, Butter SH. The effects of postoperative peridural analgesia on pulmonary therapy and pulmonary complications. Anesthesiology. 1974;41:8-17.

Glynn CJ, Mather LE, Cousins MJ. Spinal narcotics and respiratory depression. Lancet II. 1979:356-357.

Gerson MC, Hurst JM, Hertzberg VS. Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med. 1990;88:101-107.

Sparrow D, O’connor GT, Rosner B. The influence of age and level of pulmonary function on nonspecific airway responsiveness. Am Rev Respir Dis. 1991;143:978-982.

Pontoppidan H, Beecher HK. Progressive loss of protective reflexes in the airway with the advance of age. JAMA. 1960;174:2209-2213.

Manawadu BR, LaForce FM. Impairment of pulmonary antibacterial defense mechanisms by halothane anesthesia. Chest. 1979;75(^sSuppl):242-243.

Smith IM. Infections in the elderly. Hosp Pract. 1982;17:69-77.

Lee-Chiong Jr TL, Matthay RA. Lung cancer in the elderly patient. Clin Chest Med. 1993;14:453-478.

Guinard JP, Mavrocordatos P, Chiolero R. A randomized comparison of intravenous versus lumbar and thoracic epidural fentanyl for analgesia after thoracotomy. Anesthesiology. 1992;77:1108-1115.

Fratacci MD, Kimball WR, Wain JC. Diaphragmatic shortening after thoracic surgery in humans: effects of mechanical ventilation and thoracic epidural anesthesia. Anesthesiology. 1993;79:654-665.

Ford GT, Rosenal TW, Chergue F. Respiratory physiology in upper abdominal surgery. Clin Chest Med. 1993;14:237-252.

Auler Jr JOC, Zin WA, Caldeira MPR. Pre and postoperative inspiratory mechanics in ischemic and valvular heart disease. Chest. 1987;92:984-990.

Spicher J, White D. Outcome and function following prolonged mechanical ventilation. Arch Intern Med. 1987;174:421-425.

Shapiro N, Zabatino SM, Ahmed S. Determinants of pulmonary function in patients undergoing coronary bypass operations. Ann Thorac Surg. 1990;50:268-273.

Pontoppidan H, Geffin B, Lowenstein E. Acute respiratory failure in the adult. N Engl J Med. 1972;287:690-698.

Bolton JW, Weiman DS, Haynes JL. Stair climbing as an indicator of pulmonary function. Chest. 1987;92:783-788.

Olsen GN, Bolton JW, Weiman DS. Stair climbing as an exercise test to predict the postoperative complications of lung resection: Two years’ experience. Chest. 1991;99:587-590.

Wood CD, Glover J, McCune M. The effect of intravenous nutrition on muscle mass and exercise capacity in perioperative patients. Am J Surg. 1989;158:63-67.

Beaty TH, Newill CA, Cohen BH. Effects of pulmonary function on mortality. J Chron Dis. 1985;38:703-710.

Allen SJ. Respiratory considerations in the elderly surgical patient. Clin Anesthesiol. 1986;4:899-930.

Rich MW, Keller AJ, Schechtman KB. Morbidity and mortality of cardiac bypass surgery in patients 75 of age or older. Ann Thorac Surg. 1988;46:638-644.

Dales RE, Dionne G, Leech JA. Preoperative prediction of pulmonary complications following thoracic surgery. Chest. 1993;104:155-159.

Forrest JB, Rehder K, Cahalan MK. Multicenter study of general anesthesia: III. Predictors of severe perioperative adverse outcomes. Anesthesiology. 1992;76:3-15.

Rigg JRA, Jones NL. Clinical assessment of respiratory function. Br J Anaesth. 1978;50:3-13.

Zibrak JD, O’ Donnell CR, Marton K. Indications for pulmonary function testing. Ann Intern Med. 1990;112:763-771.

Gupta SD, Gibbins FJ, Sem I. Routine chest radiography in the elderly. Age Ageing. 1985;14:11-14.

Wahi R, McMurtrey MJ, DeCaro LF. Determinants of perioperative morbidity and mortality after pneumectomia. Ann Thorac Surg. 1989;48:33-37.

Kearney DJ, Lee TH, Reilly JJ. Assessment of operative risk in patients undergoing lung resection: Importance of predicted pulmonary function. Chest. 1994;105:753-759.

Keagy BA, Pharr WF, Bowes DE. A review of morbidity and mortality in elderly patients undergoing pulmonary resection. Am Surg. 1984;50:213-216.

Keeling P, Gillen P, Hennessy TP. Esophageal resection in the elderly. Ann R Coll Surg. 1988;70:34-37.

Osterberg T, Era P, Gause-Nilson I. Dental state and functional capacity in 75-year-olds three Nordic localities. J Oral Rehabil. 1995;22:653-660.

Verbeken EK, Cauberghs M, Mertens I. The senile lung: comparison with normal and emphysematous lungs 2: Functional aspects. Chest. 1992;101:800-809.

Carvalhaes-Neto N, Lorino H, Gallinari C. Cognitive function and assessment of lung function in the elderly. Am J Respir Crit Care Med. 1995;152:1611-1615.

Christopherson R, Beattie C, Frank SM. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Anesthesiology. 1993;79:422-434.

Hirshman CA, Edelstein G, Peetz S. Mechanism of action of inhalational anesthesia on airways. Anesthesiology. 1982;56:107-111.

Coon RL, Kampine JP. Hypocapnic bronchoconstriction and inhalation anesthetics. Anesthesiology. 1975;43:635-641.

Gyetko MR, Toews GB. Immunology of the aging lung. Clin Chest Med. 1993;14:379-391.

Taeger K, Weninger F, Schmelzer F. Pulmonary kinetics of fentanyl and alfentanil in surgical patients. Br J Anaesth. 1988;61:425-434.

Yasuda I, Hirano T, Yusa T. Tracheal constriction by morphine and fentanyl in man. Anesthesiology. 1978;19:117-119.

Ruiz Neto PP, Auler Jr JOC. Respiratory mechanical properties during fentanyl and alfentanil anaesthesia. Can J Anaesth. 1992;39:458-465.

Salomaki TE, Laitinen JO, Nuutinen LS. A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anesthesiology. 1991;75:790-795.

Mangano DT, Layung EL, Wallace A. Effect of atenolol on mortality and cardiovascular morbidity after noncardiac surgery. N Engl J Med. 1996;335:1713-1720.

Shulman M, Sandler NA, Bradley JW. Postthoracotomy pain and pulmonary function following epidural and systemic morphine. Anesthesiology. 1984;61:569-575.

Varrassi G, Celleno P, Capogna G. Ventilatory effects of subarachnoid fentanyl in the elderly. Anaesthesia. 1992;47:558-562.

Sharrock NE, Cazan MG, Hargett MJ. Changes in mortality after total hip and knee arthroplasty over a tem year period. Anesth Analg. 1995;80:242-248.

Sandler NA, Stringer D, Panos L. A randomized, double-blind comparison of lumbar epidural and intravenous fentanyl infusions for posthoracotomy pain relief: analgesic, pharmacokinetic, and respiratory effects. Anesthesiology. 1992;77:626-634.

Munoz HR, Dagnino JA, Rufs JA. Benzodiazepine premedication causes hypoxemia during spinal anesthesia in geriatric patients. Reg Anesth. 1992;17:139-142.

Salvatore AJ, Sullivan SF, Papper EM. Postoperative hypoventilation and hypoxemia in man after hyperventilation. N Engl J Med. 1969;280:467-470.

Bailey PL, Pace NL, Ashbum MA. Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology. 1990;73:826-830.

Reeder MK, Goldman MD, Loh L. Postoperative hypoxemia after major abdominal vascular surgery. Br J Anaesth. 1992;68:23-26.

Arunasalam K, Davenport HT, Painter S. Ventilatory response to morphine in young and old subjects. Anaesthesia. 1983;38:529-533.

Egbert AM, Parks LH, Short LM. Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men. Arch Intern Med. 1990;150:1897-1903.

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