Neurointensive care: Postoperative management
The population of elderly people is increasing with an increase in life expectancy, leading to an increase in the number of surgeries in the elderly. Elderly patients undergoing surgery are at higher risk of postoperative complications due to physiological decline, multiple comorbidities, polypharmacy, cognitive dysfunction, and frailty. In old age, there is an increase in systolic blood pressure and decrease in diastolic blood pressure due to arterial stiffness. Postoperative complications result in increased morbidity and mortality and poor surgical outcomes. A decrease in the amplitude of esophageal contractions and number of peristaltic movements in old age leads to a delayed gastric emptying time in comparison to younger individuals. With aging there is a gradual decline in arterial oxygenation. There is reduced tidal volume and higher respiratory rate in the elderly in comparison to younger subjects. Nephrotoxic drugs and use of osmotic diuretics, as is common in neurosurgery patients, has to be done with close monitoring and extreme caution.