|LETTER TO EDITOR
|Year : 2023 | Volume
| Issue : 2 | Page : 93-94
Preoperative evaluation in geriatric patients – Response
Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
|Date of Submission||06-Apr-2023|
|Date of Acceptance||08-Apr-2023|
|Date of Web Publication||28-Apr-2023|
Dr. Bimla Sharma
Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi - 110 060
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sharma B. Preoperative evaluation in geriatric patients – Response. Curr Med Res Pract 2023;13:93-4
We thank the author of the correspondence for the interest shown in our article, 'Preoperative Evaluation in geriatric patients: Are we over-investigating'?
We would like to comment on the points of disagreement. Dr Gupta mentions that demography does matter. In our article, we wrote, 'The elderly are also susceptible to substance abuse, such as alcohol consumption'. At least two alcoholic beverages are consumed daily by 8% of women and 13% of men over 65. The reference to this is not from India but from the USA. The study by Blazer and Wu assessed the prevalence, distribution and correlates of at-risk alcohol use (particularly binge drinking) amongst middle-aged and older Americans and compared women's and men's usage.
Chronic illnesses such as cardiovascular disease, arthritis and diabetes have increased alongside the ageing of the population. Substance abuse is the only chronic condition that has historically decreased with age. However, baby boomers have other characteristics not seen in other ageing populations, such as heavy drug use in earlier life.
The National Family Health Survey-5 report surveyed approximately 6.37 lakh sample households in India and concluded that, compared to 16.6% of men, a mere 2% of women consumed alcohol in the age group of 65 and above. According to the report, there is regional variation in alcohol consumption.
In our article, we mentioned that there are numerous pre-operative investigation protocols for the elderly. According to NICE guidelines, individuals with American Society of Anesthesiologists (ASA) categories III and IV require an electrocardiogram (ECG). Patients with ASA status II having intermediate surgery also need a pre-operative ECG. An ECG is also indicated for patients with any ASA status undergoing major or complex procedures. In asymptomatic patients undergoing low-risk surgical procedures, pre-operative and post-operative 12-lead resting ECGs are unnecessary (level of evidence: B).
As stated in our article, the incidence of diabetes mellitus is high in the Indian population.
In order to detect the disease's insidious impact on several systems in the body, including the cardiovascular system, it would be advised that these patients have an ECG as part of the pre-anaesthesia evaluation. Hence, the article begs the question, are we doing too many pre-operative investigations on elderly individuals in India? Definitely not.
Safety for the geriatric individual depends on taking a detailed history of comorbidities, and the metabolic equivalent ability of the patient, then examining the results of the appropriate investigations and planning the anaesthetic management according to the risk quotient of the planned surgery.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Sharma B, Sahai C, Sood J. Preoperative evaluation in geriatric patients: Are we over-investigating? Curr Med Res Pract 2022;12:173.
Gupta H. Preoperative evaluation in geriatric patients – Demography does matter. Curr Med Res Pract 2023;13:45.
Blazer DG, Wu LT. The epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: National survey on drug use and health. Am J Psychiatry 2009;166:1162-9.
Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: The challenges ahead. Lancet 2009;374:1196-208.
Yarnell S, Li L, MacGrory B, Trevisan L, Kirwin P. Substance use disorders in later life: A review and synthesis of the literature of an emerging public health concern. Am J Geriatr Psychiatry 2020;28:226-36.
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al.
2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014;64:e77-137.