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DOI: 10.13189/ujmsj.2013.010204
http://www.hrpub.org
Abstract
Keywords
1. Introduction
Aging is a complex and multifactorial process that
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Definition
cognitive
Delirium
Altered pharmacodynamics
Stroke
Hyperalgesia
Persistent deterioration of
cognitive performance after
surgery, most often resolves
within 3 months, but can last
longer
Decline in mental status,
reduced awareness, cognitive
and psychomotor dysfunction,
disorientation, and memory
impairment
Increased effect of drug on the
body; example exaggerated
respiratory and cardiovascular
depression from narcotics
Decreased blood supply to the
brain due to ischemia or
hemorrhage. There is an
increased risk in elderly,
because
of
autonomic
dysfunction,
decreased
baroreceptor sensitivity, and
loss of vascular elasticity.
Paradoxical increase in pain
intensity, new pain complaints
and altered pain characteristics
while receiving treatment with
opioids.
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Unfractionated
heparin
LMWH
Dosage
Recommendations
SC BID
No contraindications
SC TID
IV
loading
dose
SC
daily
SC BID
Warfarin
NSAIDS
Ticlopidine
Delay 14 days
Clopidogrel
Delay 7 days
Herbal therapy
No contraindications
independantly
Fenamates
GPIIB/IIIA Antagonists
used
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Aspirin
Diflunisal
Salsalate
Diclofenac
Ketorolac
Meclofenamate
Mefenamic acid
Tolmetin
Etodolac
Indomethacin
Sulindac
Fenoprofen
Flurbiprofen
Ibuprofen
Ketoprofen
Naproxen
Oxaprozin
Meloxicam
Nabumetone
Piroxicam
Celecoxib
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Acetaminophen
Amitriptyline
Clomipramine
Desipramine
Imipramine
Maprotiline
Nortriptyline
MAOIs
Selegiline
Tranylcypromine
SSRIs
Citalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
SNRIs
Desvenlafaxine
Duloxetine
Venlafaxine
Anticonvulants
Carbamazepine
Lamotrigine
Oxcarbazepine
Phenytoin
Valproic acid
Topiramate
Baclofen
Pregabalin
Gabapentin
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Cyclobenzaprine
Capsaicin
Tizanidine
Diclofenac
Lidocaine
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8. Conclusion
Pain management in the elderly and cognitively impaired
is associated with specific complicating elements
surrounding perioperative events.Geriatric patients typically
suffer from a greater number of co-morbid diseases, have
lower organ function reserve, and demonstrate altered
physiologic and pharmacologic reactions.There are also
unique challenges in pain assessment.For example, it may
require more time for older patients to understand the pain
scale due to barriers such as vision, hearing or cognitive
defects.In addition, elderly patients also tend to underreport
pain and effective perioperative pain management requires
careful assessment of pain and sensible dosing of
analgesics.It is also crucial to be aware of potential AEs
secondary to analgesic options and to keep a close watch for
adverse effect development.
Incorporating perioperative regional anesthesia/analgesia
and multimodal drug therapy may prove to be the most
effective approach to perioperative pain management in the
elderly and cognitively impaired with the least amount of
physiological compromise.Regional anesthesia may benefit
older patients by reducing postoperative neurological,
pulmonary, cardiac and endocrine complications and.to
potentially improve immediate postoperative pain control,
Acknowledgements
Commercial or institutional resources did not sponsor this
article and author received no financial support.The author
has no conflict of interest with regard to this manuscript.
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