Thoracic surgery clinics
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Thoracic surgery clinics · Aug 2009
ReviewPostoperative pain management in the elderly undergoing thoracic surgery.
The management of postoperative pain in the elderly represents a considerable challenge because these patients are generally at higher risk for postoperative complications. There are several analgesic options, some of which may influence perioperative morbidity in this high-risk group of patients. Although use of regional analgesia, particularly epidural analgesia is associated with some benefits, including a decrease in perioperative morbidity, there are side effects and complications (eg, medication-related side effects, epidural hematoma, infection) from these and other techniques, and the clinician should evaluate the benefits and risks of each technique on an individual basis. Nevertheless, the available data suggest that use of regional analgesic techniques (ie, epidural and paravertebral catheters) is associated with a decrease in perioperative pulmonary complications.
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Thoracic surgery clinics · Aug 2009
ReviewPreoperative evaluation and risk assessment for elderly thoracic surgery patients.
Assessment for thoracic surgery in elderly patients should proceed on the basis of physiologic rather than chronologic age. Thoracic surgery has been shown to be safe in selected elderly patients, and age should not be a contraindication to a therapy that offers the best chance of cure for early stage cancer patients. ⋯ Specialized multidisciplinary care provided by primary care physicians, geriatric specialists, cardiologists, oncologists, surgeons, anesthesia personnel, nurses, physical therapists, and nutritionists will optimize care for the elderly thoracic surgery patient. Careful selection of patients for surgery has contributed to the improvement in operative mortality over time, and refinements in preoperative testing should continue this trend in the future.
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Thoracic surgery clinics · Aug 2009
Evaluation and management of the elderly patient at risk for postoperative delirium.
Geriatric patients are at a high risk for the development of postoperative delirium. By recognizing predisposing and precipitating risk factors, preventive measures can be undertaken to reduce this risk. Accurate and timely diagnosis is essential, and we offer therapeutic strategies to help reduce the high morbidity and mortality of this important condition.