Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

Kathleen N Johnson,1 Daniel B Botros,1 Leanne Groban,1–4 Yvon F Bryan11Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; 2Section on Molecular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; 3Sticht Cent...

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Autores principales:	Johnson KN, Botros DB, Groban L, Bryan YF
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	airway management aging intubation ventilation Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/46156c022ad24241918162796f38d66c
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spelling	oai:doaj.org-article:46156c022ad24241918162796f38d66c2021-12-02T04:50:57ZAnatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management1178-1998https://doaj.org/article/46156c022ad24241918162796f38d66c2015-12-01T00:00:00Zhttps://www.dovepress.com/anatomic-and-physiopathologic-changes-affecting-the-airway-of-the-elde-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Kathleen N Johnson,1 Daniel B Botros,1 Leanne Groban,1–4 Yvon F Bryan11Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; 2Section on Molecular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; 3Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA; 4Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube. Also, some of these changes, including but not limited to, atrophy of the muscles around the lips and an edentulous mouth, affect bag mask ventilation due to a difficult face-mask seal. Physiopathologic changes may impact airway management as well. Common pulmonary issues in the elderly (eg, obstructive sleep apnea and COPD) increase the risk of an oxygen desaturation event, while gastrointestinal issues (eg, achalasia and gastroesophageal reflux disease) increase the risk of aspiration. Finally, cognitive changes (eg, dementia) not often seen as related to airway management may affect patient cooperation, especially if an awake intubation is required. Overall, degradation of the airway along with other physiopathologic and cognitive changes makes the elderly population more prone to complications related to airway management. When deciding which airway devices and techniques to use for intubation, the clinician should also consider the difficulty associated with ventilating the patient, the patient’s risk of oxygen desaturation, and/or aspiration. For patients who may be difficult to bag mask ventilate or who have a risk of aspiration, a specialized supralaryngeal device may be preferable over bag mask for ventilation. Patients with tumors or decreased neck range of motion may require a device with more finesse and maneuverability, such as a flexible fiberoptic bronchoscope. Overall, geriatric-focused airway management is necessary to decrease complications in this patient population.Keywords: intubation, ventilation, oxygenation, aspiration, elderly, anesthesiaJohnson KNBotros DBGroban LBryan YFDove Medical Pressarticleairway managementagingintubationventilationGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 10, Pp 1925-1934 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	airway management aging intubation ventilation Geriatrics RC952-954.6
spellingShingle	airway management aging intubation ventilation Geriatrics RC952-954.6 Johnson KN Botros DB Groban L Bryan YF Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management
description	Kathleen N Johnson,1 Daniel B Botros,1 Leanne Groban,1–4 Yvon F Bryan11Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA; 2Section on Molecular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA; 3Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA; 4Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC, USAAbstract: There are many anatomical, physiopathological, and cognitive changes that occur in the elderly that affect different components of airway management: intubation, ventilation, oxygenation, and risk of aspiration. Anatomical changes occur in different areas of the airway from the oral cavity to the larynx. Common changes to the airway include tooth decay, oropharyngeal tumors, and significant decreases in neck range of motion. These changes may make intubation challenging by making it difficult to visualize the vocal cords and/or place the endotracheal tube. Also, some of these changes, including but not limited to, atrophy of the muscles around the lips and an edentulous mouth, affect bag mask ventilation due to a difficult face-mask seal. Physiopathologic changes may impact airway management as well. Common pulmonary issues in the elderly (eg, obstructive sleep apnea and COPD) increase the risk of an oxygen desaturation event, while gastrointestinal issues (eg, achalasia and gastroesophageal reflux disease) increase the risk of aspiration. Finally, cognitive changes (eg, dementia) not often seen as related to airway management may affect patient cooperation, especially if an awake intubation is required. Overall, degradation of the airway along with other physiopathologic and cognitive changes makes the elderly population more prone to complications related to airway management. When deciding which airway devices and techniques to use for intubation, the clinician should also consider the difficulty associated with ventilating the patient, the patient’s risk of oxygen desaturation, and/or aspiration. For patients who may be difficult to bag mask ventilate or who have a risk of aspiration, a specialized supralaryngeal device may be preferable over bag mask for ventilation. Patients with tumors or decreased neck range of motion may require a device with more finesse and maneuverability, such as a flexible fiberoptic bronchoscope. Overall, geriatric-focused airway management is necessary to decrease complications in this patient population.Keywords: intubation, ventilation, oxygenation, aspiration, elderly, anesthesia
format	article
author	Johnson KN Botros DB Groban L Bryan YF
author_facet	Johnson KN Botros DB Groban L Bryan YF
author_sort	Johnson KN
title	Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management
title_short	Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management
title_full	Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management
title_fullStr	Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management
title_full_unstemmed	Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management
title_sort	anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/46156c022ad24241918162796f38d66c
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Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management

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