Characteristics of anesthetic management in elderly patients with frailty syndrome
DOI:
https://doi.org/10.14739/2310-1210.2025.2.318211Keywords:
anesthesia, frailty syndrome, analgesiaAbstract
The increase in the proportion of elderly people has led to a proportional increase in geriatric patients undergoing surgical treatment. Elderly patients often develop geriatric syndromes, one of which is the frailty syndrome.
Aim. Based on the analysis of scientific literature, to emphasize the specifics of anesthetic care for surgeries in patients with frailty syndrome.
Materials and methods. To achieve the goal, a search and analysis of full-text articles in the PubMed, Web of Science, Google Scholar, Scopus databases was conducted using the key terms “frailty syndrome” and “anesthesia”, including randomized controlled trials and meta-analyses and covering English- and Ukrainian-language publications over the past 10 years (from September 2014 to September 2024). A total of 390 publications were selected and analyzed.
Results. Currently, more than 20 different tools for assessing frailty are known in the literature. The most suitable for preoperative assessment were the Clinical Frailty Scale, the FRAIL scale, and the most informative was the Comprehensive Geriatric Assessment. Strictly controlled general anesthesia with extended monitoring and continuous adjustment of almost all organ functions should be considered for most frail patients when choosing an anesthesia method. Aging affects the pharmacokinetics and pharmacodynamics of drugs. The dosage of most modern anesthetic agents should be reduced by 25–75 % in patients with senile frailty. In the postoperative period, rational analgesia and cardiorespiratory monitoring should be provided.
Conclusions. The anesthetic management plan should include a detailed preoperative assessment, selection of the optimal method of intraoperative analgesia, structured intraoperative procedures, and a course of postoperative treatment with adequate pain relief. Optimal perioperative management of patients with frailty syndrome requires close interdisciplinary, interprofessional, and interdisciplinary collaboration to minimize adverse postoperative outcomes.
References
Khan MS, Segar MW, Usman MS, Singh S, Greene SJ, Fonarow GC, et al. Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial. JACC Heart Fail. 2022;10(4):266-275. doi: https://doi.org/https://doi.org/10.1016/j.jchf.2021.12.004
Lin HS, McBride RL, Hubbard RE. Frailty and anesthesia - risks during and post-surgery. Local Reg Anesth. 2018;11:61-73. doi: https://doi.org/https://doi.org/10.2147/LRA.S142996
World report on ageing and health. World Health Organization 2015. https://iris.who.int/handle/10665/186463
Keller DS, Curtis N, Burt HA, Ammirati CA, Collings AT, Polk HC Jr, et al. EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults. Surg Endosc. 2024;38(8):4104-26. doi: https://doi.org/https://doi.org/10.1007/s00464-024-10977-7
Lin HS, McBride RL, Hubbard RE. Frailty and anesthesia - risks during and post-surgery. Local Reg Anesth. 2018;11:61-73. doi: https://doi.org/https://doi.org/10.2147/LRA.S142996
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487-92. doi: https://doi.org/https://doi.org/10.1111/j.1532-5415.2012.04054.x
Jin Z, Rismany J, Gidicsin C, Bergese SD. Frailty: the perioperative and anesthesia challenges of an emerging pandemic. J Anesth. 2023;37(4):624-40. doi: https://doi.org/https://doi.org/10.1007/s00540-023-03206-3
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al.; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56. doi: https://doi.org/https://doi.org/10.1093/gerona/56.3.m146
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: https://doi.org/https://doi.org/10.1503/cmaj.050051
Lewis ET, Dent E, Alkhouri H, Kellett J, Williamson M, Asha S, et al. Which frailty scale for patients admitted via Emergency Department? A cohort study. Arch Gerontol Geriatr. 2019;80:104-14. doi: https://doi.org/https://doi.org/10.1016/j.archger.2018.11.002
Olotu C, Weimann A, Bahrs C, Schwenk W, Scherer M, Kiefmann R. The Perioperative Care of Older Patients. Dtsch Arztebl Int. 2019;116(5):63-9. doi: https://doi.org/https://doi.org/10.3238/arztebl.2019.0063
Loskutov OA, Bondar MV, Todurov BM, Gumenyuk MI, Halushko OA, Markov YI, et al. Otsinka peredoperatsiynoho statusu patsiyenta i pidhotovka do khirurhichnoho vtruchannya [Assessment of the patient's preoperative status and preparation for surgery]. Kyiv, Ukraine; 2019.
de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104-14. doi: https://doi.org/https://doi.org/10.1016/j.arr.2010.09.001
Feng Y, Sun JF, Wei HC, Cao Y, Yao L, Du BX. Correlation Between Anesthesia Methods and Adverse Short-Term Postoperative Outcomes Depending on Frailty: A Prospective Cohort Study. Clin Interv Aging. 2024;19:613-26. doi: https://doi.org/https://doi.org/10.2147/CIA.S448898
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16(7):601-8. doi: https://doi.org/https://doi.org/10.1007/s12603-012-0084-2
Partridge JS, Harari D, Martin FC, Dhesi JK. The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. Anaesthesia. 2014;69 Suppl 1:8-16. doi: https://doi.org/https://doi.org/10.1111/anae.12494
Mohanty S, Rosenthal RA, Russell MM, Neuman MD, Ko CY, Esnaola NF. Optimal Perioperative Management of the Geriatric Patient: A Best Practices Guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg. 2016;222(5):930-47. doi: https://doi.org/https://doi.org/10.1016/j.jamcollsurg.2015.12.026
Amer MA, Smith MD, Herbison GP, Plank LD, McCall JL. Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg. 2017;104(3):187-97. doi: https://doi.org/https://doi.org/10.1002/bjs.10408
Memtsoudis SG, Rasul R, Suzuki S, Poeran J, Danninger T, Wu C, et al. Does the impact of the type of anesthesia on outcomes differ by patient age and comorbidity burden? Reg Anesth Pain Med. 2014;39(2):112-9. doi: https://doi.org/https://doi.org/10.1097/AAP.0000000000000055
Van Zundert TC, Gatt SP, van Zundert AA. Anesthesia and perioperative pain relief in the frail elderly patient. Saudi J Anaesth. 2023;17(4):566-74. doi: https://doi.org/https://doi.org/10.4103/sja.sja_628_23
Ploschenko YO, Stanin DM, Khalimonchyk VV. Osoblyvosti anesteziyi u patsiyentiv litnʹoho viku [Peculiarities of anesthesia in elderly patients]. Hostri ta nevidkladni stany v praktytsi likaria. 2016;(6):5-13. Ukrainian.
Kruijt Spanjer MR, Bakker NA, Absalom AR. Pharmacology in the elderly and newer anaesthesia drugs. Best Pract Res Clin Anaesthesiol. 2011;25(3):355-65. doi: https://doi.org/https://doi.org/10.1016/j.bpa.2011.06.002
Steinmetz J, Rasmussen LS. The elderly and general anesthesia. Minerva Anestesiol. 2010;76(9):745-52.
O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023 Aug;14(4):625-32. doi: https://doi.org/https://doi.org/10.1007/s41999-023-00777-y
Compendium. Medicinal products. Available from: https://compendium.com.ua
Santa Cruz Mercado LA, Liu R, Bharadwaj KM, Johnson JJ, Gutierrez R, Das P, et al. Association of Intraoperative Opioid Administration With Postoperative Pain and Opioid Use. JAMA Surg. 2023;158(8):854-64. doi: https://doi.org/https://doi.org/10.1001/jamasurg.2023.2009
McLachlan AJ, Bath S, Naganathan V, Hilmer SN, Le Couteur DG, Gibson SJ, et al. Clinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment. Br J Clin Pharmacol. 2011;71(3):351-64. doi: https://doi.org/https://doi.org/10.1111/j.1365-2125.2010.03847.x
Butterworth J, Mackey D, Wasnick J. Morgan and Mikhail’s clinical anesthesiology, seventh edition. 7th ed. Columbus, OH: McGraw-Hill Education; 2022.
Kotani Y, Pruna A, Turi S, Borghi G, Lee TC, Zangrillo A, et al. Propofol and survival: an updated meta-analysis of randomized clinical trials. Crit Care. 2023;27(1):139. doi: https://doi.org/https://doi.org/10.1186/s13054-023-04431-8
Wei Y, Jia L, Cheng S, Ma W, An X, Xu Z. Efficacy and safety of ciprofol for general anesthesia induction in female patients with frailty: a prospective randomized controlled trial. BMC Anesthesiol. 2024;24(1):396. doi: https://doi.org/https://doi.org/10.1186/s12871-024-02776-3
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-94. doi: https://doi.org/https://doi.org/10.1111/jgs.15767
Clegg A, Young JB. Which medications to avoid in people at risk of delirium: a systematic review. Age Ageing. 2011;40(1):23-9. doi: https://doi.org/https://doi.org/10.1093/ageing/afq140
Li JQ, Yuan H, Wang XQ, Yang M. Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery. World J Clin Cases. 2023;11(16):3756-64. doi: https://doi.org/https://doi.org/10.12998/wjcc.v11.i16.3756
Wang Y, Bu X, Zhao N, Wang S, Wang X, Ge Y, et al. Dexmedetomidine effect on delirium in elderly patients undergoing general anesthesia: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021;100(48):e27782. doi: https://doi.org/https://doi.org/10.1097/MD.0000000000027782
Lim BG, Lee IO. Anesthetic management of geriatric patients. Korean J Anesthesiol. 2020;73(1):8-29. doi: https://doi.org/https://doi.org/10.4097/kja.19391
Lee LA, Athanassoglou V, Pandit JJ. Neuromuscular blockade in the elderly patient. J Pain Res. 2016;9:437-44. doi: https://doi.org/https://doi.org/10.2147/JPR.S85183
Fortier LP, McKeen D, Turner K, de Médicis É, Warriner B, Jones PM, et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth Analg. 2015;121(2):366-72. doi: https://doi.org/https://doi.org/10.1213/ANE.0000000000000757
Chan SP, Ip KY, Irwin MG. Peri-operative optimisation of elderly and frail patients: a narrative review. Anaesthesia. 2019;74 Suppl 1:80-9. doi: https://doi.org/https://doi.org/10.1111/anae.14512
Sessler DI. Perioperative Temperature Monitoring. Anesthesiology. 2021;134(1):111-8. doi: https://doi.org/https://doi.org/10.1097/ALN.0000000000003481
De Simone B, Chouillard E, Podda M, Pararas N, de Carvalho Duarte G, Fugazzola P, et al. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World J Emerg Surg. 2024;19(1):18. doi: https://doi.org/https://doi.org/10.1186/s13017-024-00537-8
Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105-20.
Auckley ED, Bentov N, Zelber-Sagi S, Jeong L, Reed MJ, Bentov I. Frailty status as a potential factor in increased postoperative opioid use in older adults. BMC Geriatr. 2021;21(1):189. doi: https://doi.org/https://doi.org/10.1186/s12877-021-02101-4
Kanchanasurakit S, Arsu A, Siriplabpla W, Duangjai A, Saokaew S. Acetaminophen use and risk of renal impairment: A systematic review and meta-analysis. Kidney Res Clin Pract. 2020;39(1):81-92. doi: https://doi.org/https://doi.org/10.23876/j.krcp.19.106
White S, Handel J. Anaesthesia for the elderly. Oxford University Press; 2018. doi: https://doi.org/https://doi.org/10.1093/med/9780198719410.003.0032
Pickering G, Kotlińska-Lemieszek A, Krcevski Skvarc N, O'Mahony D, Monacelli F, Knaggs R, et al. Pharmacological Pain Treatment in Older Persons. Drugs Aging. 2024;41(12):959-76. doi: https://doi.org/https://doi.org/10.1007/s40266-024-01151-8
Barnett SR. Polypharmacy and perioperative medications in the elderly. Anesthesiol Clin. 2009;27(3):377-89, table of contents. doi: https://doi.org/https://doi.org/10.1016/j.anclin.2009.07.004
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