Tag Archives: guidelines

Guidelines for peri-op care of patients with dementia

Reference: White et al.

2019 Mar;74(3):357-372. doi: 10.1111/anae.14530. Epub 2019 Jan 11

https://www.aagbi.org/sites/default/files/perioperative_care_of_people_with_dementia.pdf

 

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Take home messages:

  • Screen – ‘do you have any concerns about your memory?’
  • Prepare patient, carers and MDT approach
  • Grant carer/relative access to anaesthetic room and recovery if needed
  • Minimum dose and duration of anaesthetic agent as needed. Titrate to BIS. Personally I’d take this as avoidance of GA if possible e.g. using spinal/regional likely to be preferable if it can be achieved safely and effectively
  • Try to avoid: benzos, opioids, cyclizine, tramadol.
  • Cholinesterase inhibitors e.g. rivastigmine: theoretical benefit of stopping day before surgery when neuromuscular blockers may be used… However balance this against risk of worsening cognitive / neuropsychiatric function. My anecdotal experience is of discontinuation causing more harm than good in general, though each case should be judged on an individual basis.
  • Similarities to principles of anaesthetic management of frail and elderly patients in general.

Unanticipated difficult intubation – DAS guidelines 2015

Updates & take-home messages:

  • Laryngoscopy -> SAD -> FM ventilation -> cricothyroidotomy
  • If poor view at laryngoscopy remove cricoid under direct vision + suction at hand
  • Use second generation SAD device
  • Removed cricoid for SAD insertion
  • Successful SAD = ‘stop and think’ moment
  • CICO -> paralyse, continue supraglottic O2 attempts -> front-of-neck
  • Laryngeal handshake
  • Front-of-neck = scalpel (No.10, broad blade), bougie, 6.0mm COETT

 

  • Limit the number of airway interventions
  • DO NOT REPEAT SAME TECHNIQUE
  • First attempt is the best. Make it so.
  • Use apnoeic oxygenation in high risk patients
  • Neuromuscular blockade (rocuronium)

https://www.das.uk.com/guidelines/das_intubation_guidelines