🎙️ Episode 45: Mind the Gap – Perioperative Pearls for Older Adults

🧠 Clinical Context

Patients over 65 undergoing inpatient surgery face unique risks. Cognitive impairment, frailty, and increased vulnerability to delirium demand a proactive and nuanced approach to anesthesia and postoperative care.

🔍 Preoperative Priorities

• Age ≥65 and inpatient status should automatically trigger a frailty and cognitive assessment
• Engage a multidisciplinary team early—geriatrics, anesthesia, surgery, and nursing

🛌 Postoperative Delirium: A Common Pitfall

• Use dexmedetomidine in the PACU or ICU setting for sedation/delirium prevention
• Avoid these culprits:
  • Benzodiazepines
  • Antipsychotics
  • Anticholinergics
  • Ketamine
  • Corticosteroids
  • Gabapentin

💡 Practical Strategy

• Optimize environment: quiet, well-lit rooms with clocks and calendars
• Encourage mobility and family engagement
• Hydrate, monitor electrolytes, and manage pain thoughtfully
• Avoid over-sedation and unnecessary polypharmacy

🧩 Clinical Takeaway

Older adults need tailored perioperative management. Screening for frailty and cognition is just as important as lab work and EKGs. Avoid high-risk meds, plan for delirium prevention, and build a team around the patient.

🎯 When it comes to older surgical patients: less is more, and team-based care is everything.

Key Reference: Sieber F et al. 2025 ASA Practice Advisory for Perioperative Care of Older Adults. Anesthesiology. 2025 Jan;142(1):22–51. PMID: 39655991