Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000500014
Brazilian Journal of Anesthesiology
Miscellaneous

Peculiaridades no pós-operatório de cirurgia cardíaca no paciente idoso

Peculiarities of post-cardiac surgery care in elderly patients

Paulo de Oliveira Vasconcelos Filho; Maria José Carvalho Carmona; José Otávio Costa Auler Júnior

http://dx.doi.org/10.1590/S0034-70942004000500014 Braz J Anesthesiol, vol.54, n5, p.707-727, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: O paciente idoso tem características fisiológicas próprias e, muitas vezes, pode apresentar deficiências orgânicas ou afecções graves, que por si, já tornam o pós-operatório complicado. O objetivo deste artigo é apresentar uma revisão das condutas pós-operatórias de cirurgia cardíaca no idoso, apresentando as alterações mais freqüentes nesse tipo de paciente. CONTEÚDO: As condutas no período intra-operatório do paciente idoso devem ser tomadas tendo em vista a diminuição da morbidade pós-operatória. Na chegada do paciente idoso à UTI, devem ser cumpridos os mesmos critérios utilizados na internação de outros pacientes adultos de cirurgia cardíaca, para o serviço ter sempre um padrão, que não leve a uma alteração na rotina e que não provoque equívocos. Estabelecer um plano de cuidados intensivos para o pós-operatório de cirurgia cardíaca irá resultar em uma ótima utilização de recursos da unidade, em efetividade de atenção e em diminuição do tempo nos cuidados em relação ao paciente idoso. Os exames auxiliares solicitados também devem seguir um padrão, estabelecido pelo serviço, a não ser que alterações sejam identificadas. Complicações neurológicas, pulmonares, circulatórias, insuficiência renal, infecção e hipotireoidismo são freqüentes, com particularidades no idoso. Elas estão delineadas neste artigo e devem ser bem compreendidas pelo intensivista que cuida desse tipo de paciente. CONCLUSÕES: As complicações apresentadas neste artigo são as que trazem maior preocupação ao intensivista, quando há um paciente idoso em pós-operatório de cirurgia cardíaca na UTI. Este paciente necessita de cuidados especiais, mesmo quando a cirurgia transcorre em perfeita normalidade, pois o estresse cirúrgico é muito grande e o idoso tem reserva funcional diminuída.

Palavras-chave

AVALIAÇÃO PÓS-OPERATÓRIA, CIRURGIA, Cardíaca, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Elderly patients have their own physiologic characteristics, and sometimes may have organic deficits or severe diseases, which by themselves may complicate the postoperative period. This article is aimed at reviewing post-cardiac surgery procedures in the elderly, describing their most frequent problems. CONTENTS: Elderly patients intraoperative approaches should be decided taking into account lower postoperative morbidity. At ICU arrival, the same criteria for other adult patients of cardiac surgeries should be adopted to maintain service standardization and routine, thus preventing mistakes. Establishing an intensive care plan for the post-cardiac surgery period may result in optimal use of resources, effective attention and decreased time of care. Subsidiary exams should also follow the standards of the service, unless any problem be identified. Neurological, pulmonary and circulatory complications, renal failure, infections and hypothyroidism outlined in this article are frequent and unique in the elderly, and should be fully understood by the ICU physician. CONCLUSIONS: Complications outlined in this article are those of greatest concern for the ICU physician when there are elderly patients in the post-cardiac surgery period. These patients need special care, even when surgery is perfectly normal, because there is major surgical stress and the elderly have decreased functional reserves.

Keywords

COMPLICATIONS, POSTOPERATIVE EVALUATION, SURGERY, Cardiac

Referencias

Alfonso F, Azcona L, Perez-Vizcayno MJ. Initial results and long-term clinical and angiographic implications of coronary stenting in elderly patients. Am J Cardiol. 1999;83:1843-1847.

Beliveau MM, Multach M. Perioperative care for the elderly patient. Med Clin North Am. 2003;87:273-289.

Rady MY, Ryan T, Starr NJ. Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med. 1998;26:225-235.

Aziz S. Cardiovascular surgery in the elderly. Cardiol Clin. 1999;17:213-231.

Chung OY, Beattie C, Friesinger GC. Assessment of cardiovascular risks and overall risks for noncardiac surgery. Cardiol Clin. 1999;17:197-211.

Lakatta EG. Cardiovascular aging in health. Clin Geriatr Med. 2000;16:419-444.

Priebe HJ. The aged cardiovascular risk patient. Br J Anaesth. 2000;85:763-778.

Pascual J, Orofino L, Liano F. Incidence and prognosis of acute renal failure in older patients. J Am Geriatr Soc. 1990;38:25-30.

Turner JS. Difficulties in predicting outcome in cardiac surgery patients. Crit Care Med. 1995;23:1843-1850.

Fulop T, Kurta G, Varga P. Body composition in hypertensive elderly and middle-aged patients. Gerontology. 1991;37:214-220.

Lakatta EG. Cardiovascular aging research: next horizons. J Am Geriatr Soc. 1999;47:613-625.

Meyer JS, Terayama Y, Takashima S. Cerebral circulation in the elderly. Cerebrovasc Brain Metab Rev. 1993;5:122-146.

Otto RA. Rapid recovery after coronary artery bypass grafting: is the elderly patient eligible?. Ann Thorac Surg. 1997;63:634-639.

Hinchman DA, Otto CM. Valvular disease in the elderly. Cardiol Clin. 1999;17:137-158.

Muravchick S. Anesthesia for the Elderly. Anesthesia. 2000:2140-2142.

Wallace DC. Diseases of the mitochondrial DNA. Annu Rev Biochem. 1992;61:1175-1212.

Lindeman RD. Is the decline in renal function with normal aging inevitable?. Geriatr Nephrol Urol. 1998;8:7-9.

MacLachlan MJ. The aging kidney. Lancet. 1978;2:143.

Tresch DD. Clinical manifestations, diagnostic assessment, and etiology of heart failure in elderly patients. Clin Geriatr Med. 2000;16:445-456.

Lampert R, Ezekowitz MD. Management of arrhythmias. Clin Geriatr Med. 2000;16:593-618.

Choi JY, Morris JC, Hsu CY. Aging and cerebrovascular disease. Neurol Clin. 1998;16:687-711.

Tresch DD, Thakur RK. Ventricular arrhythmias in the elderly. Emerg Med Clin North Am. 1998;16:627-648.

Chan ED, Welsh CH. Geriatric respiratory medicine. Chest. 1998;114:1704-1733.

Greaves S, Rutherford J, Aranki S. Current incidence and determinants of perioperative myocardial infarction in coronary artery surgery. Am Heart J. 1996;132:572-578.

Eagle KA, Guyton RA, Davidoff R. ACC/AHA Guidelines for coronary artery bypass surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery). J Am Coll Cardiol. 1999;34:1262-1347.

Del Guercio LR, Cohn JD. Monitoring operative risk in the elderly. JAMA. 1980;243:1351-1355.

Ryckwaert F, Boccara G, Frappier JM. Incidence, risk factors, and prognosis of a moderate increase in plasma creatinine early after cardiac surgery. Crit Care Med. 2002;30:1495-1498.

Loef BG, Epema AH, Navis G. Off-pump coronary revascularization attenuates transient renal damage compared with on-pump coronary revascularization. Chest. 2002;121:1190-1194.

Solomon DH, Burton JR, Lundebjerg NE. The new frontier: increasing geriatrics expertise in surgical and medical specialties. J Am Geriatr Soc. 2000;48:702-704.

Vaughan MS, Vaughan RW, Cork RC. Postoperative hypothermia in adults: relationship of age, anesthesia, and shivering to rewarming. Anesth Analg. 1981;60:746-751.

Leong CS, Cascade PN, Kazerooni EA. Bedside chest radiography as part of a postcardiac surgery critical care pathway: a means of decreasing utilization without adverse clinical impact. Crit Care Med. 2000;28:383-388.

Kugler JP, Hustead T. Hyponatremia and hypernatremia in the elderly. Am Fam Physician. 2000;61:3623-3630.

Smith DL. Anemia in the elderly. Am Fam Physician. 2000;62:1565-1572.

Yung RL. Changes in immune function with age. Rheum Dis Clin North Am. 2000;26:455-473.

Tresch DD. Management of the older patient with acute myocardial infarction: difference in clinical presentations between older and younger patients. J Am Geriatr Soc. 1998;46:1157-1162.

Berman AR. Pulmonary embolism in the elderly. Clin Geriatr Med. 2001;17:107-130.

Tresch DD. Evaluation and management of cardiac arrhythmias in the elderly. Med Clin North Am. 2001;85:527-550.

Benoit DD, Vandewoude KH, Decruyenaere JM. Cardiac troponin I: its contribution to the diagnosis of perioperative myocardial infarction and various complications of cardiac surgery. Crit Care Med. 2001;29:1880-1886.

Rich MW. Heart failure. Cardiol Clin. 1999;17:123-135.

Lobo SM, Salgado PF, Castillo VG. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med. 2000;28:3396-3404.

Pascual J, Liano F, Ortuno J. The elderly patient with acute renal failure. J Am Soc Nephrol. 1995;6:144-153.

Finucane P, Anderson C. Thyroid disease in older patients. Diagnosis and treatment.. Drugs Aging. 1995;6:268-277.

Tresch DD, Thakur RK. Cardiopulmonary resuscitation in the elderly. Beneficial or an exercise in futility?. Emerg Med Clin North Am. 1998;16:649-663.

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