Prompt

84-year-old, CFS 5, for emergency laparotomy on an ACE inhibitor and a DOAC — what dose, what monitoring, where afterwards?

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State the one-line answer first: halve the dose and titrate, score the frailty, hold the ACE inhibitor, run the delirium bundle — mortality rises steeply with frailty.^[1]^[11]

References8Show

[1]Coetzee E Pharmacokinetic and Pharmacodynamic Changes in the Elderly: Impact on Anesthetics. Anesthesiol Clin, 2023.PMID 37516494
[2]Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001.PMID 11253156
[3]Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ, 2005.PMID 16129869
[4]Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet, 1998.PMID 9525362
[11]Price A, Pearce L, Griffiths J, et al. Estimating the effect of frailty on longer-term survival following emergency laparotomy: an observational study using National Emergency Laparotomy Audit data. Anaesthesia, 2025.PMID 40432239
[15]Douketis JD, Spyropoulos AC, Duncan J, et al. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med, 2019.PMID 31380891
[9]Wang YY, Yue JR, Xie DM, et al. Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults: A Randomized Clinical Trial. JAMA Intern Med, 2020.PMID 31633738
[18]Wang E, Belley-Côté EP, Young J, et al. Effect of perioperative benzodiazepine use on intraoperative awareness and postoperative delirium: a systematic review and meta-analysis of randomised controlled trials and observational studies. Br J Anaesth, 2023.PMID 36621439

Opening

State the one-line answer first: halve the dose and titrate, score the frailty, hold the ACE inhibitor, run the delirium bundle — mortality rises steeply with frailty.^[1]^[11]

References8Show

[1]Coetzee E Pharmacokinetic and Pharmacodynamic Changes in the Elderly: Impact on Anesthetics. Anesthesiol Clin, 2023.PMID 37516494
[2]Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001.PMID 11253156
[3]Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ, 2005.PMID 16129869
[4]Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet, 1998.PMID 9525362
[11]Price A, Pearce L, Griffiths J, et al. Estimating the effect of frailty on longer-term survival following emergency laparotomy: an observational study using National Emergency Laparotomy Audit data. Anaesthesia, 2025.PMID 40432239
[15]Douketis JD, Spyropoulos AC, Duncan J, et al. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med, 2019.PMID 31380891
[9]Wang YY, Yue JR, Xie DM, et al. Effect of the Tailored, Family-Involved Hospital Elder Life Program on Postoperative Delirium and Function in Older Adults: A Randomized Clinical Trial. JAMA Intern Med, 2020.PMID 31633738
[18]Wang E, Belley-Côté EP, Young J, et al. Effect of perioperative benzodiazepine use on intraoperative awareness and postoperative delirium: a systematic review and meta-analysis of randomised controlled trials and observational studies. Br J Anaesth, 2023.PMID 36621439

Anaesthesia for the elderly and the co-morbid patient — Viva

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Anaesthesia for the elderly and the co-morbid patient — Viva

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