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Major abdominal surgery in the elderly 

Major abdominal surgery in the elderly
Chapter:
Major abdominal surgery in the elderly
Author(s):

Dave Murray

DOI:
10.1093/med/9780199604999.003.0023
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date: 18 August 2019

This chapter reviews the care of the elderly patient presenting for abdominal surgery, which is one of the highest risk areas of anaesthetic practice. The important aspects of risk/benefit assessment are discussed followed by key areas of anaesthetic management, including fluid balance, temperature control, managing blood loss, and analgesia. Positioning for abdominal procedures presents challenges for elderly patients and the surgical team, and these are discussed from an anaesthetic perspective. Specific fields of practice are then covered. Gastric surgery is usually for either cancer or haemorrhage and the poor state of the latter group is emphasized. The range of colorectal surgery and the development of ‘enhanced recovery’ systems in this area are discussed. Finally, emergency intra-abdominal surgery is discussed with an emphasis on the poor outcome in this group of patients and their need for prompt, appropriately skilled care and often postoperative critical care.

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