Special Populations
By Tracey Carpenter
Pediatric Patients
• Ages between birth and 12 years of age
– Neonates- the first 28 days of life
– Infant- 1 to 18 months
– Toddler- 18 to 30 months
– Preschooler- 30 months to 5 years
– School Age- 6 to 12 years
Communication
• Fearful of separation from family and
• Unfamiliar surroundings
– Unknown people all covered up
– Can only see eyes
• Lack of understanding and communicative skills

Calming Fears
• Allow child to bring a favorite toy with them
• Don’t have too many people in the room
• Stay quiet and calm
– Why
• Anesthesia and circulator are only ones to interact with pt
– Accept if child becomes combative
– Restrain only to prevent the child from hurting themselves
Intra-operative Considerations
• Temperature
– Less fat, poor thermal insulation
– Monitored either with skin or rectal thermometers
• Shock
– Septic shock
• due to infection
– Hypovolemic
• due to dehydration and bleeding
Birth Trauma
• *Cord compression
• Broken clavicle
• Facial paralysis
• *Placental abruption
Obese Patients
• 100 lbs or more over ideal weight
• Increased morbidity and mortality due to:

Considerations
• Transportation
– Some must be transported on their hospital bed into the OR
– Sometimes two OR beds must be used
– Sometimes (seldom) the operation must be done on the hospital bed
– Extra personnel needed to transport for saftey
Respect
• Pts are usually self conscious
• Keep negative comments to yourself
• Keep exposure to a minimum
Anesthesia Complications
• May need a cut down for venous access
• Difficult intubation due to lack of movement in the neck
• Poor ventilation
• Need for more anesthetic agents
Intra-operative Considerations
• Need for longer instrumentation
• Longer surgical time due to lack of exposure
• As with all surgical procedures counts must be accurate
– There is more of a chance that something could be left behind in deep incisions
Post-operative Considerations
• Longer healing time
– Adipose tissue in the obese has decreased blood supply
• Increased likelihood of wound infection
• Wound dehiscence
• Pulmonary embolism
• Post operative asphyxia due to sleep apnea
• Leaks at anastomosis sites……

Geriatrics
• The term geriatric is taken from the Greek word yeros, which means old.
• People over the age of 65 are considered elderly
• Elderly people may maintain their functional capabilities throughout their life time.
• The main influence on aging depend on their genetic, environment, and lifestyle
Geriatrics
• Gerontology - is the study of all aspects in aging to include, physiologic, psychologic, economic, and sociologic problems and consideration of the aging person.
• Life expectancy has increased with major advancements in the study of the disease process, prevention and treatment
Geriatrics
• The US Dept. of Health and Human Services indicate that a person born in;
– 1954 expect to live to 68 years of age
– 1988 expect to live to 74 years of age
– By 2030, 1 in 10 will be older than 85 years of age with only 41% of the population below the age of 35
– The median age will be 40 y/o
– With the increase life expectancy and decrease in mortality the largest patient population will be geriatrics
Geriatrics
• As the life expectancy increase so does the rate of comorbidity.
• Comorbidity – the existence of two or more disease process in a single pt
– ie a pt with coronary artery disease, may also have osteoporosis, may also be hypertensive and be diabetic.
• Comorbidity is also a major consideration in the attainment of expected outcome.
Geriatrics
• Aging is viewed from many perspectives, some positive & some negative
• The positive aspects are;
– Maturity & wealth of knowledge
• The negative aspects are:
– Debilitation
– Pervading weakness & dependence at the end of their life
Geriatrics
• Major organ systems affected by the aging process:
– Central Nervous System
– Musculoskeletal System
– Cardiovascular System
• Other systems include:
– Gastrointestinal Endocrine
– Genitourinary Integumentary
Geriatric Surgery
• The surgical team needs to be aware of the physical, psychological, and social status of the geriatric pt.
Surgical Considerations
• Ease with bruising or laceration
• Loss of mobility in joints
• Ease of fx’s and strains
• Lack of ability to tolerate episodes of hypoxia
• Potential lack of understanding
Geriatric Surgery
• The normal changes of the aging process present the surgical team with a wide variety of needs
– Protecting the pt’s skin and joints
– Temperature loss
– Fluid dynamics
– Cardiovascular response
Geriatric Surgery
• Questions to ask yourself
– Is the room temp OK?
– Is there sufficient padding on the OR bed?
– How is the pt’s skin condition?
– How flexible is the pt?
– What is the mental status of the pt?
– What specific complications are most likely with this pt’s?
Trauma
• #1 health care issue in the world
• About 160,000 Americans die each year from trauma
• Difficult to diagnose and treat because most trauma victims have multiple types of injuries
• When working with a trauma team the ST must be ready to do almost every type of surgery
Trauma Centers
• Level I
– Meets all needs required for trauma patients on a 24 hour basis
• Level II
– Can treat seriously ill and injured pts but not to the extent of Level I
• Level III & IV
– Usually a community or rural hospital. Trauma pts are stabilized and transported to a Level I
Types of Trauma

Blunt
&
Penetrating

Blunt Trauma
• Skin is usually unbroken
• Injury to the underlying tissues and organs
• Makes diagnosis difficult
• Examples include:
– Car accidents, falls, battery and sports injuries
Penetrating Trauma
• When a foreign object passes through tissue
• The most common are bullets and knives
• Extent of injury depends on the size and type of foreign object and how many tissues and/or organs that are affected
Penetrating objects
• Should never be removed in the until in the operating room
• The object acts as a tampenade for bleeding
• If it is removed before in an area that can take care of this then the patient may die from subsequent bleeding
Questions?