Evaluación de riesgos quirúrgicos y manejo post cirugía del adulto mayor de 80 años / Evaluation of surgical risk and post-surgical treatment of elderly over 80 year

Chile vive un envejecimiento acelerado, con expectativas de vida en aumento. Por otra parte, la tendencia a operar adultos mayores ha sido mayor que la esperada sólo por el envejecimiento de la población. Sin embargo, las complicaciones perioperatorias son más frecuentes en los ancianos. Entre otras razones destaca su mayor comorbilidad y el fenómeno de “homeoestenosis”. Todo esto determina que el paciente anciano requiera evaluaciones y cuidados especiales en el peri-operatorio. Esta revisión explica y discute el rol del Médico Geriatra y de la Evaluación Geriátrica Integralen reducir la morbi-mortalidad peri-quirúrgica del adulto mayor, especialmente del mayor de 80 años; resaltando los componentes de comorbilidad, medicamentos, funcionalidad y exámenes complementarios. También se discuten las principales medidas a considerar en el postoperatorio.

Chile is experiencing a process of accelerated aging with increasing in life expectancies. On the other hand, the tendency to operate elderly patients has been greater than that just explained by that of the aging population. Nevertheless, peri-operative complications are more common for the elderly than for the younger patient. Among other reasons, they have more comorbidities and the “homeoestenosis” phenomenon. All this explains why the elderly patient needs special care and evaluation in the peri-operative period. This review discuses and explains the importance of the Comprehensive Geriatric Assessment and the Geriatrician in reducing morbidity and mortality in the elderly patient, especialy over 80 years of age; emphasizing comorbidity, medications, functionality and lab testing. We also discuss the principal measures that must be considered on the postoperative period.

Efecto del entrenamiento muscular inspiratorio en el costo de oxígeno de la ventilación en pacientes con enfermedad pulmonar obstructiva crónica / Effects of inspiratory muscle training on the oxygen cost of breathing in patients with chronic obstructive pulmonary disease

Background: Patients with chronic obstructive pulmonary disease have an increased inspiratory work, since they must overcome high loads due to increased airway resistance. Aim: To determine if the reduction in the metabolic cost of exercise observed in patients with chronic obstructive pulmonary disease (COPD) after inspiratory muscle training, was due to a reduction in the oxygen cost of breathing. Patients and methods: Nine patients with COPD (FEV1 39 ñ 13 percent) subjected to inspiratory muscle training, using a training load of 30 percent of maximal inspiratory pressure, during 10 weeks; 5 patients with COPD (FEV1 44 ñ 18 percent) not subjected to training, and 7 healthy controls (FEV1 110 ñ 10 percent) were studied. The cost of breathing was calculated as the difference in VO2 measured at rest and after breathing a gas mixture containing air and 5 percent CO2. Exercise VO2 was measured at submaximal exercise. Results: Oxygen cost of breathing was increased in patients with COPD and it was inversely correlated with FEV1 (r= -0.86 p<0.001). Inspiratory muscle training increased maximal inspiratory pressure and decreased exercise VO2. Oxygen cost of breathing increased in six and decreased in three trained patients. Changes in this parameter after training did not correlate with the reduction in exercise VO2 or the increment in maximal inspiratory pressure. Conclusions: The reduction in exercise VO2 after inspiratory muscle training is not due to a reduction in the oxygen cost of breathing