: Age related alterations in respiratory function-anesthetic considerations [ Article de synthèse : Les modifications de fonction respiratoire liées à l ’ âge – considérations anesthésiques ]

Purpose: This review examines the effect of aging on pulmonary reserve. Special emphasis is placed on how anesthetic and surgical factors may impose substantial stresses on the respiratory system of elderly patients, leading to increased risk for postoperative pulmonary complications including respiratory failure. Source: A MEDLINE-based English-language literature search was undertaken for the period 1966–2006, and an EMBASE search covered the overlapping period 1988–2006. Selected articles were limited to those applying to elderly subjects/patients. Principal findings: Age-related loss of the lung static recoil forces, stiffening of the chest wall and diminished alveolar surface area lead to a decrease in vital capacity, an increase in residual volume, decrease in expiratory flows and increased ventilation-perfusion heterogeneity. Respiratory muscle strength consistently declines with age further increasing the work of breathing. While gas exchange may be well preserved at rest and during exertion, pulmonary reserve is diminished, and under conditions of positive fluid balance, positioning for surgery, and increased metabolic demand, postoperative respiratory failure can occur. Increased sensitivity to respiratory depressants and muscle weakness pose additional risks for the development of postoperative respiratory complications in elderly patients. Regional anesthetic techniques provide for superior postoperative analgesia, without necessarily altering the frequency of postoperative pulmonary complications in the older surgical population. Conclusion: Alterations in respiratory physiology associated with aging must be appreciated to anticipate and minimize potential complications associated with surgery and anesthesia in the elderly. Individualized care to optimize preoperative cardiorespiratory function, minimize intraoperative respiratory pertubations, and to gently restore postoperative pulmonary function are essential anesthetic goals for elderly patients who require surgery. Objectif : Cet article traite de l’effet du vieillissement sur la réserve pulmonaire. En particulier, on se tourne vers les facteurs anesthésiques et chirurgicaux qui imposent un stress substantiel sur le système respiratoire des patients âgés, en les mettant à risque de complications respiratoires postopératoires, dont l’insuffisance respiratoire. Source : Une recherche des articles publiés en langue anglaise de 1966 à 2006 a été entreprise en se servant de MEDLINE. La période 1988–2006 a aussi été fouillée avec EMBASE. On a sélectionné que les articles portant sur les patients ou sujets âgés. Constatations principales : Avec l’âge, l’atténuation de la force statique de recul des poumons, la rigidité de la cage thoracique et la diminution de la surface des alvéoles produit une réduction de la capacité vitale, une augmentation du volume résiduel, une diminution des débits expiratoires et une plus grande inadéquation ventilationperfusion. La force des muscles respiratoires diminue constamment avec l’âge, ce qui augmente le travail respiratoire. L’échange gazeux est normal au repos et pendant l’exercice, mais la réserve pulmonaire est diminuée. Ainsi, avec une surcharge liquidienne, un positionnement pour la chirurgie et une demande métabolique accrue, une insuffisance respiratoire peut survenir en période postopératoire. Les patients âgés sont plus sensibles aux médicaments qui dépriment la respiration et leurs muscles sont plus faibles, d’où un risque augmenté de complications respiratoires postopératoires. Les techniques d’anesthésie loco-régionales produisent une analgésie postopératoire de qualité, sans toujours modifier l’incidence de complications pulmonaires postopératoires chez les sujets âgés. Conclusion : On doit tenir compte des changements physiologiques respiratoires découlant du vieillissement pour prévoir et atténuer les complications qui peuvent survenir suite à une chirurgie et une anesthésie chez les sujets âgés. L’anesthésiologiste doit viser un traitement individualisé pour optimiser la fonction cardiorespiratoire avant la chirurgie, limiter l’atteinte respiratoire pendant la chirurgie et assurer une récupération en douceur de la fonction pulmonaire en postopératoire. CARDIOTHORACIC ANESTHESIA, RESPIRATION AND AIRWAY

[1]  D. Silage,et al.  Effects of aging on ventilatory and occlusion pressure responses to hypoxia and hypercapnia. , 2015, The American review of respiratory disease.

[2]  R. Cavallazzi,et al.  Aspiration pneumonitis and aspiration pneumonia. , 2009, The New England journal of medicine.

[3]  V. Lawrence,et al.  Preoperative Pulmonary Risk Stratification for Noncardiothoracic Surgery: Systematic Review for the American College of Physicians , 2006, Annals of Internal Medicine.

[4]  M. Aronson,et al.  Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the American College of Physicians , 2006, Annals of Internal Medicine.

[5]  V. Lawrence,et al.  Strategies To Reduce Postoperative Pulmonary Complications after Noncardiothoracic Surgery: Systematic Review for the American College of Physicians , 2006, Annals of Internal Medicine.

[6]  D. O. Warner.  Perioperative Abstinence from Cigarettes: Physiologic and Clinical Consequences , 2006, Anesthesiology.

[7]  B. Williams,et al.  The Effects of the Alveolar Recruitment Maneuver and Positive End-Expiratory Pressure on Arterial Oxygenation During Laparoscopic Bariatric Surgery , 2006, Anesthesia and analgesia.

[8]  R. Arora.  Dyspnea in the elderly. , 2005, The American journal of medicine.

[9]  D. O. Warner.  Helping Surgical Patients Quit Smoking: Why, When, and How , 2005, Anesthesia and analgesia.

[10]  V. Ranieri,et al.  Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. , 2005, JAMA.

[11]  A. Anzueto,et al.  Noninvasive positive-pressure ventilation for respiratory failure after extubation. , 2004, The New England journal of medicine.

[12]  S. Kavic,et al.  Assessment and management of the geriatric patient , 2004, Critical care medicine.

[13]  K. Turnheim.  When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly , 2003, Experimental Gerontology.

[14]  P. Marik,et al.  Aspiration pneumonia and dysphagia in the elderly. , 2003, Chest.

[15]  G. Tomlinson,et al.  Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. , 2003, American journal of respiratory and critical care medicine.

[16]  E. Haponik,et al.  Respiratory failure in elderly patients. , 2003, Clinics in geriatric medicine.

[17]  S. Wicky,et al.  Morbid Obesity and Postoperative Pulmonary Atelectasis: An Underestimated Problem , 2002, Anesthesia and analgesia.

[18]  P. Myles,et al.  Epidural block and outcome after major surgery , 2002, The Medical journal of Australia.

[19]  C. Meinert,et al.  Double-masked Randomized Trial Comparing Alternate Combinations of Intraoperative Anesthesia and Postoperative Analgesia in Abdominal Aortic Surgery , 2001, Anesthesiology.

[20]  Anthony Rodgers,et al.  Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials , 2000, BMJ : British Medical Journal.

[21]  M. Kleinhenz,et al.  Chronic ventilator dependence in elderly patients. , 2000, Clinics in geriatric medicine.

[22]  J. Rodarte,et al.  Mechanism of reduced maximal expiratory flow with aging. , 2000, Journal of applied physiology.

[23]  W. Henderson,et al.  Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery , 2000, Annals of surgery.

[24]  D. O. Warner,et al.  Preventing postoperative pulmonary complications: the role of the anesthesiologist. , 2000, Anesthesiology.

[25]  C. Rylander,et al.  The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation , 2000, Intensive Care Medicine.

[26]  E. Lucchinetti,et al.  Respiratory function in the elderly. , 2000, Anesthesiology clinics of North America.

[27]  E. Ely,et al.  Mechanical Ventilation in a Cohort of Elderly Patients Admitted to an Intensive Care Unit , 1999, Annals of Internal Medicine.

[28]  T. Babb,et al.  Progressive mechanical ventilatory constraints with aging. , 1999, American journal of respiratory and critical care medicine.

[29]  D. Schroeder,et al.  Airway obstruction and perioperative complications in smokers undergoing abdominal surgery. , 1999, Anesthesiology.

[30]  L. Skovgaard,et al.  Residual neuromuscular block is a risk factor for postoperative pulmonary complications A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium , 1997, Acta anaesthesiologica Scandinavica.

[31]  E. Sforza,et al.  Respiratory effort during obstructive sleep apnea: role of age and sleep state. , 1997, Chest.

[32]  M. Polkey,et al.  The contractile properties of the elderly human diaphragm. , 1997, American journal of respiratory and critical care medicine.

[33]  J H Wilmore,et al.  Twenty-year follow-up of aerobic power and body composition of older track athletes. , 1997, Journal of applied physiology.

[34]  R. Marthan,et al.  Pulmonary gas exchange in elderly subjects. , 1996, The European respiratory journal.

[35]  M. Moulton,et al.  Obesity is not a risk factor for significant adverse outcomes after cardiac surgery. , 1996, Circulation.

[36]  L. F. Thompson.  Failure to wean: exploring the influence of age-related pulmonary changes. , 1996, Critical care nursing clinics of North America.

[37]  L. Neas,et al.  The determinants of pulmonary diffusing capacity in a national sample of U.S. adults. , 1996, American journal of respiratory and critical care medicine.

[38]  M. Wysocki,et al.  Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. , 1995, The New England journal of medicine.

[39]  C. Tinelli,et al.  Reference values of arterial oxygen tension in the middle-aged and elderly. , 1995, American journal of respiratory and critical care medicine.

[40]  S. Kelsen,et al.  Comparison of diaphragm strength between healthy adult elderly and young men. , 1995, American journal of respiratory and critical care medicine.

[41]  J A Dempsey,et al.  Longitudinal effects of aging on lung function at rest and exercise in healthy active fit elderly adults. , 1995, Journal of applied physiology.

[42]  M. Schell,et al.  Factors Associated with Postoperative Pulmonary Complications in Patients with Severe Chronic Obstructive Pulmonary Disease , 1995, Anesthesia and analgesia.

[43]  G. Hedenstierna,et al.  Reexpansion of atelectasis during general anaesthesia may have a prolonged effect , 1995, Acta anaesthesiologica Scandinavica.

[44]  J. Dempsey,et al.  Impact of the aging pulmonary system on the response to exercise. , 1994, Clinics in chest medicine.

[45]  G. Hedenstierna,et al.  Re-expansion of atelectasis during general anaesthesia: a computed tomography study. , 1993, British journal of anaesthesia.

[46]  Pjl.  Pulmonary Disease in the Elderly Patient , 1993 .

[47]  J. Bourgain,et al.  Postoperative Pulmonary Complications Epidural Analgesia Using Bupivacaine and Opioids Versus Parenteral Opioids , 1993, Anesthesiology.

[48]  S. Peters,et al.  A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. , 1992, The American review of respiratory disease.

[49]  B. Lachmann,et al.  Open up the lung and keep the lung open , 1992, Intensive Care Medicine.

[50]  P. Williams-Russo,et al.  Predicting postoperative pulmonary complications. Is it a real problem? , 1992, Archives of internal medicine.

[51]  K. P. Van de Woestijne,et al.  The senile lung. Comparison with normal and emphysematous lungs. 1. Structural aspects. , 1992, Chest.

[52]  G. Hedenstierna,et al.  Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia. , 1992, British journal of anaesthesia.

[53]  J. Magovern,et al.  Pressure support ventilation with a simplified ventilatory support system administered with a nasal mask in patients with respiratory failure. , 1991, Chest.

[54]  G. Hedenstierna,et al.  Chronic obstructive pulmonary disease and anaesthesia: formation of atelectasis and gas exchange impairment. , 1991, The European respiratory journal.

[55]  S. Valentine,et al.  Preoxygenation in the Elderly: A Comparison of the Four‐Maximal‐Breath and Three‐Minute Techniques , 1990, Anesthesia and analgesia.

[56]  Daniel J Buysse,et al.  Comparison of sleep-disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. , 1990, Sleep.

[57]  T. Pedersen,et al.  A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity , 1990, Acta anaesthesiologica Scandinavica.

[58]  V. Hertzberg,et al.  Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. , 1990, The American journal of medicine.

[59]  V. Lawrence,et al.  Preoperative spirometry before abdominal operations. A critical appraisal of its predictive value. , 1989, Archives of internal medicine.

[60]  M. Hetzel,et al.  Maximal expiratory flow-volume curves in Londoners aged 60 years and over. , 1987, Thorax.

[61]  A. Walker,et al.  Adverse respiratory events occurring in the recovery room after general anesthesia. , 1986, Anesthesiology.

[62]  A. Haas,et al.  Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly. , 1985, Archives of physical medicine and rehabilitation.

[63]  P. Krumpe,et al.  The aging respiratory system. , 1985, Clinics in geriatric medicine.

[64]  B. Celli,et al.  A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. , 1984, The American review of respiratory disease.

[65]  A I Pack,et al.  Effect of Aging on Ventilatory Response to Exercise and CO2 , 1984, Journal of applied physiology: respiratory, environmental and exercise physiology.

[66]  W. M. Wahba,et al.  Influence of Aging on Lung Function‐Clinical Significance of Changes from Age Twenty , 1983, Anesthesia and analgesia.

[67]  R. Hyatt.  Expiratory flow limitation. , 1983, Journal of applied physiology: respiratory, environmental and exercise physiology.

[68]  H. Kazemi,et al.  Aging and the respiratory system. , 1983, The Medical clinics of North America.

[69]  L. Larsson.  Histochemical characteristics of human skeletal muscle during aging. , 1983, Acta physiologica Scandinavica.

[70]  M. Altose,et al.  Effect of aging on the perception of resistive ventilatory loads. , 1982, The American review of respiratory disease.

[71]  M. Altose,et al.  Effect of aging on respiratory sensations produced by elastic loads. , 1981, Journal of applied physiology: respiratory, environmental and exercise physiology.

[72]  G. Hedenstierna,et al.  Airway Closure During Anaesthesia, and its Prevention by Positive End Expiratory Pressure , 1980, Acta anaesthesiologica Scandinavica.

[73]  M. Lebowitz,et al.  The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. , 1976, The American review of respiratory disease.

[74]  W. Thurlbeck,et al.  Growth and aging of the normal human lung. , 1975, Chest.

[75]  R. Hickey,et al.  Relationship of Preoperative Closing Volume to Functional Residual Capacity and Alveolar‐Arterial Oxygen Difference during Anesthesia with Controlled Ventilation , 1974, Anesthesiology.

[76]  D. Niewoehner,et al.  Morphologic basis of pulmonary resistance in the human lung and effects of aging. , 1974, Journal of applied physiology.

[77]  M. Becklake,et al.  "Closing volume" and its relationship to gas exchange in seated and supine positions. , 1971, Journal of applied physiology.

[78]  F. Cheney,et al.  Arterial oxygen tension in relation to age in healthy subjects. , 1969, Respiration; international review of thoracic diseases.

[79]  J. Mead,et al.  Elasticity of human lungs in relation to age. , 1968, Journal of applied physiology.

[80]  R. Hyatt,et al.  Influence of lung parenchyma on pressure-diameter behavior of dog bronchi. , 1966, Journal of applied physiology.

[81]  J. Bishop,et al.  A-a difference in O2 tension and physiological dead space in normal man. , 1963, Journal of applied physiology.

[82]  J. V. Levy,et al.  [Use of opioids in the elderly -- pharmacokinetic and pharmacodynamic considerations]. , 2004, Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS.

[83]  P. Enright,et al.  Predictors of loss of lung function in the elderly: the Cardiovascular Health Study. , 2001, American journal of respiratory and critical care medicine.

[84]  M. Shulman,et al.  Preoperative pulmonary evaluation. , 1999 .

[85]  J. Janssens,et al.  Physiological changes in respiratory function associated with ageing. , 1999, The European respiratory journal.

[86]  S. Ancoli-Israel,et al.  Are breathing disturbances in elderly equivalent to sleep apnea syndrome? , 1994, Sleep.

[87]  R. Kronmal,et al.  Spirometry reference values for women and men 65 to 85 years of age. Cardiovascular health study. , 1993, The American review of respiratory disease.

[88]  K. P. Van de Woestijne,et al.  The senile lung. Comparison with normal and emphysematous lungs. 2. Functional aspects. , 1992, Chest.

[89]  S. Lefrak,et al.  How aging affects the structure and function of the respiratory system. , 1978, Geriatrics.

[90]  R. Dripps,et al.  Postoperative atelectasis and pneumonia. , 1946, Annals of surgery.