March 26, 2015 – Premedication in Elderly

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Anchor lead: Should premedication before surgery be used in elderly people?  Elizabeth Tracey reports

When older people undergo surgery, delirium sometimes results, with delayed or sometimes permanently impaired cognitive recovery.  Can using medicines to alleviate anxiety contribute, as a recent study suggests? Joseph Califano, a head and neck surgeon at Johns Hopkins, says caution is warranted.

Califano: People tend to be much more judicious in the use of benzodiazipines in elderly patients, because there is associated delirium or disorientation around the perioperative period. One of the things we do try to do in elderly patients is minimize surgical time and minimize use of benzodiazipines and use agents that are rapid on and rapid off.   :18

Califano says sometimes such medications can be entirely avoided.

Califano: Honestly sometimes the best thing is just to talk to patients ahead of time and identify what’s really the anxiety focus for them and try to reduce that simply through counseling, and that usually ends up being a lot more effective for them anyway.   :11

At Johns Hopkins, I’m Elizabeth Tracey.