Die präoperative Vorbereitung des geriatrischen Patienten - Objektive Information und stützende Beratung

Bei der Vorbereitung des Patienten auf Operationen wachsen dem Hausarzt wichtige Aufgaben zu, die gerade beim Älteren auf der langjährigen Kenntnis und vertrauensvollen Beziehung beruhen. Denn nach dem Alter ist der verlässlichste Risikoindikator der nach ASA (American Society of Anesthesiologists) eingeschätzte Allgemeinzustand und die Größe des Eingriffs. Sinnvolle Maßnahmen des Hausarztes umfassen zum Beispiel die Einstellung eines Hypertonus, Verbesserung des Ernährungszustands, Durchführung von Atemgymnastik und Mobilisierung des Patienten sowie eine adäquate Flüssigkeitszufuhr. Wichtig ist die Übermittlung der Dauerdiagnosen und Medikamente an den Operateur oder Narkosearzt. Im Rahmen eines geriatrischen Assessments empfiehlt sich die Durchführung eines Minimal mental status vor stationären Eingriffen, da kognitive postoperative Störungen häufig sind. Die meisten Komplikationen treten erst nach dem Eingriff auf: einerseits weil der Patient während der Narkose in sicheren Händen ist, andererseits, weil gewisse pathophysiologische Bedingungen eine gewisse Latenzperiode aufweisen.

For the patient facing an operation, the family doctor has a number of important tasks to perform, which, in particular in the elderly, are validated by years of familiarity with the patient and a trusting relationship. For, the second most reliable risk indicator after age is the ASA- (American Society of Anesthesiologists) based general state of health of the patient and the severity of the surgery. Useful tasks for the family doctor include control of hypertension, improvement of nutritional sate, initiation of respiratory training, mobilization of the patient, and ensuring adequate fluid intake. Also of importance is the provision of the surgeon or anaesthetist with relevant information on the long-term diagnoses and drug use. Within the framework of a geriatric assessment, it is to be recommended that a minimal mental status test be performed prior to inpatient operations, since postoperative cognitive disturbances are common. Most complications occur after the surgery, in the first place since during the operation the patient is in reliable hands, and secondly since some pathophysiological conditions are associated with a certain latency period.

Key Words

preoperative preparation - geriatric patient - family doctor - geriatric assessment - postoperative disorders

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