Helpful As well as Wonderful R428 Ideas

Pre-operative and postoperative anaemia are common in the older surgical patient, and are associated with myocardial ischaemia, falls, poor wound healing and rehabilitation. However, there is a lack of evidence specific to the elderly surgical population about when and how much to transfuse to optimise haemoglobin concentration without incurring transfusion-related complications. Observational data suggest that patients aged >?65?years have higher mortality after major non-cardiac surgery if there is ��substantial�� operative blood loss or they have a pre-operative haematocrit http://www.selleck.cn/products/3-methyladenine.html due to be published in May 2015. Positioning of the patient on the operating table must be sympathetic to his/her musculoskeletal condition, and take into account, for example, kyphoscoliosis, arthritic joints and fixed flexion deformities. Functional splints should not be removed, if practicable. Older patients are http://www.selleckchem.com/products/r428.html at higher risk of (preventable) peripheral nerve injuries during prolonged surgery, including the ulnar nerve when supine, the common peroneal nerve in lithotomy, the dependent radial nerve in the lateral position and the brachial plexus after prolonged periods of lateral neck flexion. Lower limb compartment syndrome can result from the lithotomy position, or prolonged intra-abdominal insufflation or pelvic surgery. The Working Party recommends that probable sites of nerve injury are comprehensively padded before the start of surgery, and assessed routinely every 30?min throughout surgery. Elderly skin can be friable. Care should be taken when transferring the patient between his/her bed and the operating table, and when removing adherent items from the patient, for example, diathermy pads, tape holding the eyelids closed and surgical dressings. Similarly, friable skin is more prone to thermal damage, hence care should be taken with contact warming devices. Hair should not be removed with a razor. Reduced skin depth http://www.selleckchem.com/products/PF-2341066.html and vascularity, together with reduced muscle mass, predispose the older patient to (preventable) tissue pressure necrosis, usually over bony protuberances, such as the heel. Prolonged hypotension may contribute to the development of pressure necrosis. ��Pressure sores�� interfere with functional recovery, may be complicated by infection and pain, and contribute to delayed discharge. Positioning, together with appropriate fluid therapy and antithrombotic measures, reduces the risk of peri-operative thrombo-embolism in the elderly [19]. The choice of anaesthesia �C regional or general �C appears to be of less importance than how sympathetically it is administered with regard to the patient's pathophysiological status.