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Chapter 45. Perioperative Regional Anesthesia in the Elderly

How have the United States elderly patient population demographics changed over the last 100 years and what impact will the changing demographics have on perioperative services?

A. Geriatric population growth impacts surgical treatment services through increased number of surgical procedures along with increased utilization of perioperative services.

B. Patients over age 65 years represent approximately 12% of the population, account for 33% of health care costs, 38% of hospital bed stays, and 21% of inpatient surgical procedures.

C. Of Medicare in-patients, 40% suffer a minor or major medical, surgical, or anesthesia-related complication(s) during hospitalization for noncardiac surgery; 8% experience a “failure to rescue” event; and 4% die in the perioperative period.

D. All of the above

D is correct. Demographics of the elderly patient population in the United States (US) have changed over the last 100 years. The entire US population almost tripled during the 20th century and the geriatric segment of the population grew tenfold alone. Only 4% of the population (less than 5 million individuals) was over 65 years old at the turn of the century, but the number of people aged 65 and older now constitutes 12% of the population. It is estimated that the number of elderly individuals will double again by 2040. The oldest old, those greater than 85 years of age, represent the fastest growing segment of the population. Currently octogenarians account for 12% of all elderly; however, they are predicted to constitute almost 20% of the elderly population by 2040. The number of centenarians is increasing even faster—from 57,000 in 1996 to an estimated/predicted 447,000 individuals by 2040.

Thus, not only is the absolute number of older Americans increasing but the overall US population is also becoming older with proportionally fewer individuals under 65 years of age.

Compared to middle-aged patients (< 50="" years),="" what="" volume="" of="" local="" anesthetic="" (la)="" should="" be="" administered="" to="" elderly="" patients="" (=""> 65 years) to achieve an adequate ultrasound-guided supraclavicular brachial plexus block (US-SCB)?

A. The same volume as the middle-aged patient population

B. Half of the volume of LA

C. One-eighth the volume of LA

D. Double the volume of LA

B is correct. The minimum effective anesthetic volume (MEAV) of LA required to achieve surgical anesthesia in 50% or 95% of the elderly population (MEAV50 and MEAV95, respectively) was studied. Authors of one study found a nearly 50% decrease in the cross-sectional area (CSA) of the brachial plexus at the level of the first rib in the elderly patients compared to middle-aged patients. In ...

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