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May 2000
Volume 64 |
Number 5
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Aging effects on normal human physiology constitutes
a major portion of the [geriatric anesthesia] syllabus,
including cardiovascular, respiratory, renal, thermoregulatory
and central nervous system aging. Additional chapters cover
how important organ systems respond to anesthesia
New Opportunities in Geriatric Anesthesia
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G. Alec Rooke, M.D.,
Chair
Committee on Geriatric Anesthesia
Now available on the ASA Web
site...Syllabus on Geriatric Anesthesia
This new syllabus contains informative, concise and scholarly
discussion on anesthesia issues pertinent to the largest growing
segment of the U.S. population. Twenty-five chapters contained
in over 70 pages discuss topics as varied as "Postoperative Delirium
in the Elderly," "Anesthetic Risk and the Elderly," "Age-Related
Disease," "Induction Agents" and "The Elderly Trauma Patient."
.
The year 2000 is shaping up to be a banner year for those interested
in geriatric anesthesia. Highlights began with a conference at
Duke University on "Cognitive Function After Non-Brain Surgery"
(see article by Madan Kwatra, Ph.D.).
The geriatric anesthesia syllabus can now be viewed or downloaded
through the ASA Web site. The ASA Annual Meeting this October
in San Francisco, California, besides providing a wide variety
of educational opportunities on geriatric anesthesia, will host
an organizational meeting in preparation for the formation of
a new society of geriatric anesthesia.
Geriatric Anesthesia Syllabus
The above-mentioned syllabus grew out of a desire by the ASA
Committee on Geriatric Anesthesia to improve education in the
field. Originally intended to assist with resident education,
the syllabus is perhaps even better suited for the busy practicing
anesthesiologist. Most chapters are under 1,000 words and provide
a quick overview of a given topic. The syllabus does not attempt
to be comprehensive, but includes 25 chapters that cover a wide
variety of topics.
Aging effects on normal human physiology constitutes a major
portion of the syllabus, including cardiovascular, respiratory,
renal, thermoregulatory and central nervous system aging. Additional
chapters cover how important organ systems respond to anesthesia.
Given that aging has such a major impact on pharmacokinetics and
pharmacodynamics, several chapters are devoted to either basic
principles or to the specifics for major classifications of anesthetic
agents. Other topics covered include preoperative risk and evaluation,
postoperative delirium, the treatment of chronic and acute pain,
palliative care, critical care and trauma, and ethical considerations
when dealing with an elderly patient.
The primary method of syllabus distribution will be via the
ASA Web site. From the site,
the syllabus can be viewed on screen or the entire document can
be downloaded in two to three minutes. The document can then be
read at leisure and printed as needed. Duplication by electronic
file or paper of all or a portion of the syllabus is permitted
for personal use or for limited distribution for educational purposes.
The syllabus is copyrighted, however, so no portion can be published
without permission from ASA. Anyone unable to access the syllabus
through the ASA Web site is welcome to contact me or ASA for alternative
methods of receiving the document.
One advantage of distributing the syllabus electronically is
the ability to make frequent revisions. We hope readers will contribute
to this process by providing their comments. Such feedback will
help to guide the Committee on Geriatric Anesthesia not only with
improvements to existing chapters but in the selection of topics
for additional chapters as well. In short, the syllabus is meant
to be a dynamic document, something that the ASA membership will
want to periodically check. The committee hopes that many individuals
will be interested in contributing to its evolution.
Educational Programs at ASA Annual Meeting
The ASA Annual Meeting this October will provide a wide variety
of educational opportunities in geriatric anesthesia. Several
refresher courses will deal with topics germane to the elderly
patient. Jacqueline M. Leung, M.D., will discuss current controversies
related to anesthetic management of geriatric patients. Gregory
J. Crosby, M.D., will present a course on how aging and anesthesia
may influence central nervous system outcome in the perioperative
period. Other refresher courses with topics pertinent to the elderly
include ethics, drug interactions, pacemakers and implantable
defibrillators, anesthesia for patients with neurological disease,
and opioid pharmacology. At least three problem-based learning
discussion sessions will revolve around elderly patients: Eugene
R. Viscusi, M.D., will discuss anesthetic and postoperative analgesia
issues for total hip replacement in the elderly; Jeffrey H. Silverstein,
M.D., will discuss a patient with Alzheimer's disease; and Jacqeline
M. Leung, M.D., will discuss an elderly patient with a murmur
undergoing a noncardiac procedure.
The committee has again organized a panel presentation related
to geriatric anesthesia on Tuesday, October 17, 2000, from 9
11 a.m., to discuss anesthetic care for ambulatory surgery in
the elderly ("Grandma on the Move"). The presentations will consist
of preoperative evaluation and preparation (Jeffrey H. Silverstein,
M.D.), perioperative adverse events and discharge criteria (Sheila
R. Barnett, M.D.), hemodynamic instability (G. Alec Rooke, M.D.),
clinical pharmacology of opioids and sedative-hypnotics (Talmage
D. Egan, M.D.) and techniques for postoperative analgesia (Raymond
C. Roy, M.D.).
Geriatric Anesthesia Grants Through FAER
The Foundation for Anesthesia Education and Research (FAER)
is actively seeking grant applications related to geriatric anesthesia.
The American Geriatrics Society (AGS) began providing financial
support to FAER last year to foster growth in geriatric research
and education within anesthesia. I am happy to report that the
AGS increased its contribution this year. The support from the
AGS can be applied toward any of the grants offered through FAER
(Research Starter Grant, New Investigator Award, Research Fellowship
or Education Grant). Currently, Deborah J. Culley, M.D., Brigham
and Women's Hospital, Harvard Medical School, has obtained a Research
Starter Grant to examine the effect of general anesthesia on the
cognitive performance and brain histochemistry in aged versus
young adult rats.
Further information on grants can be obtained at the FAER
Web site at. The next application submission deadline is August
15, 2000.
Geriatric Anesthesia Society
The last exciting news I will mention is the proposed formation
of a new professional subspeciality society devoted to geriatric
anesthesia. The ASA Committee on Geriatric Anesthesia is the catalyst
behind this initiative, which is based on the realization that
the committee's activities and the national interest in geriatrics
have grown to the point where future growth would be facilitated
by involvement of a much larger group than can be accommodated
by an ASA committee. The ASA leadership supports this endeavor
and is providing a room at the ASA Annual Meeting for the organizational
meeting (Salon A-1 of Golden Gate Hall, San Francisco Marriott
Hotel, from 9-11 a.m. on Monday, October 16, 2000). The discussion
will center around the goals and programs of the society. We hope
to have proposals for the technical aspects of society formation
(i.e., bylaws) prepared for discussion, alteration or approval
at the meeting.
Anyone interested in attending the meeting and/or joining the
society is encouraged to contact G. Alec
Rooke, M.D., . This will allow us to gauge interest and to
include all interested individuals in the discussion of the society
prior to the fall meeting.
G. Alec Rooke, M.D., is Associate Professor
of Anesthesiology at the University of Washington, Seattle, Washington.
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