, Essentials
of
Geriatric Neuroanesthesia
,
, Essentials
of
Geriatric Neuroanesthesia
Edited by
Hemanshu Prabhakar, MD, PhD
Department of Neuroanaesthesiology and Critical Care
All India Institute of Medical Sciences (AIIMS)
New Delhi, India
Coeditors
Charu Mahajan and Indu Kapoor
Department of Neuroanaesthesiology and Critical care
All India Institute of Medical Sciences (AIIMS)
New Delhi, India
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,To our grandparents
Karam Chand and Indrawati Prabhakar
Vidhya Sagar and Saraswati Agnihotri
Hemanshu Prabhakar
Amar Nath Gupta and Raj Devi
Jia Lal and Sushila Devi
Charu Mahajan
Dorje and Chimey Angmo
Norbu Gonbo and Tashi Angmo
Indu Kapoor
,
,Contents
Foreword ix
Acknowledgment xi
Contributors xiii
1 Neuroanatomy: Age-related changes 1
Vasudha Singhal
2 Neurophysiology: Age-related changes 5
Dinu Chandran, Smriti Badhwar, and Manpreet Kaur
3 Neuropharmacology: Age-related changes 19
Katleen Wyatt Chester, Olivia Johnson Morgan, and Kruti Shah
4 Preanesthetic evaluation 35
Summit Bloria and Ankur Luthra
5 Neurosurgery: Supratentorial tumors 45
Monica S. Tandon, Kashmiri Doley, and Daljit Singh
6 Neurosurgery: Posterior fossa surgery 83
Nidhi Gupta
7 Neurosurgery: Cerebrovascular diseases 105
Paolo Gritti, Luigi Andrea Lanterna, Francesco Ferri, Carlo Brembilla, and
Ferdinando Luca Lorini
8 Neurosurgery: Neuroendocrine lesions 125
Kiran Jangra
9 Neurosurgery: Spine surgery 135
M.V.S. Satya Prakash and M. Senthilnathan
10 Neurosurgery: Minimally invasive neurosurgery 149
Charu Mahajan, Indu Kapoor, and Hemanshu Prabhakar
11 Neurosurgery: Functional neurosurgery 159
Suparna Bharadwaj, Christine Dy-Valdez, and Jason Chui
12 Neuromonitoring 173
Leslie C. Jameson and Claudia F. Clavijo
,viii Contents
13 Positions in neurosurgery 189
Zilvinas Zakarevicius, Mikhail Gelfenbeyn, and Irene Rozet
14 Neurotrauma: Geriatric neurotrauma 205
Alan J. Kovar and Abhijit Lele
15 Neurointensive care: Postoperative management 211
Swagata Tripathy
16 Neurointensive care: Sedation and analgesia in the ICU 223
Marc Alain Babi
17 Neurointensive care: Postoperative cognitive dysfunction 231
Anastasia Borozdina, Ega Qeva, and Federico Bilotta
18 Special considerations: Electroconvulsive therapy 243
Dhritiman Chakrabarti and Deepti Srinivas
19 Special considerations: Alzheimer’s disease 251
Christopher G. Sinon, Sona Shah Arora, Amy D. Rodriguez, and Paul S. García
20 Special considerations: Parkinson’s disease 263
Adriana Martin and Shobana Rajan
21 Fluids and electrolyte management 271
Indu Kapoor and Robert G. Hahn
22 Palliative care in geriatric patients with neurological diseases 279
Seema Mishra and Nishkarsh Gupta
23 Brain death and ethical issues: Death by neurological criteria 289
Brittany Bolduc and David M. Greer
Index 303
, Foreword
Is there a need for a textbook on geriatric neu- mortality than those less than 80 years old, dem-
roanesthesia? A similar question was asked four onstrating the additional risk and the need for
decades ago about the need for a textbook on neu- enhanced perioperative care. Cardiovascular, pul-
roanesthesia. Now in 2019, there are a substantial monary, and metabolic risks increase with age.
number of textbooks on this subject. With complex Added to this, the polypharmacy, drug interac-
neurosurgery being undertaken in elderly patients tions, and altered response to drugs due to organ
these days, there is a definite need for a compre- dysfunction complicate the management of the
hensive textbook on geriatric neuroanesthesia. elderly patient. Cognitive function might be
Life expectancy is increasing all over the world. altered in some elderly patients, and the response
The global average of life expectancy, which was of the patient’s cognitive function to anesthetics is
48 years in 1950, increased to 70 years in 2012. In a matter of great debate.
India, life expectancy as of 2015 is 68.3 years on To address the above issues, Prabhakar et al.
the whole—69.9 years for females and 66.9 years have undertaken a massive effort of compiling a
for males. In Japan, the figure is 83.7 years for the textbook of geriatric neuroanesthesia. They have
whole population—86.8 years for females and 80.5 divided the topics to suit the practical require-
years for males. With increasing life expectancy, ments of the clinicians. In the initial chapters the
more and more elderly patients are likely to pres- age-related changes in neuroanatomy, neurophysi-
ent for surgery and anesthesia. ology, and neuropharmacology as relevant to neu-
There is a general increase in risk of surgery roanesthetic practice are discussed, followed by
with increasing age. This has been shown in hip discussion of the individual lesions and various
and knee arthroplasty. Despite the increased rate general aspects of management of the elderly, such
of adverse events, there are gains in terms of pain as fluid and electrolyte balance, pain management,
relief and ability to perform activities of daily liv- and palliative care. Overall, this book is a practical
ing, and overall most elderly groups were satisfied compendium which will be very helpful to practi-
with their surgeries. Thus there are advantages of tioners of geriatric neuroanesthesia.
surgery, though at a higher risk. A similar argu-
ment can be held with regard to neurosurgery. G.S. Umamaheswara Rao
Minimizing this risk and offering the advan- Senior Professor
tage of surgery is a big challenge. In a review of Department of Neuroanaesthesia and
octogenarians undergoing neurosurgery, only a Neurocritical Care
small proportion of the emergency admissions National Institute of Mental Health and
were discharged directly to home. Octogenarian Neuro Sciences (NIMHANS)
patients had higher complication rates and 30-day Bangalore, India
