الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Traumatic injuries in the elderly are increasing commensurately with the activeness and healthiness of the lifestyles seen in their expanding population. The annual occurrence of traumatic injuries in the elder cohort is reported to be as high as 29%. Maxillofacial trauma is typically thought of as a problem of young urban males, not as a problem of senior citizens, and it is true that elderly persons are seriously injured less frequently than any other segment of the population. However, increasing longevity, more active lifestyles, and a growth in the ratio of the elderly in the population portends an increase in the frequency of senior citizens sustaining craniofacial trauma .(1)
Perioperative management of the acutely injured elderly patient is different from the management of younger patients, and typically it is more complex. Despite their lower injury rate, geriatric patients use a disproportionate share of all health care resources associated with trauma care. Studies have examined the reasons that mortality is increased in geriatric patients after trauma. Intercurrent chronic systemic disease presumably contributes to the high morbidity and mortality rates of elderly persons who sustain relatively minor trauma injuries. Survivors were compared to nonsurvivors in 82 consecutive blunt trauma injuries in victims older than 65 years of age. Nonsurvivors were older, had more severe overall injury and more severe head and neck trauma, but did not differ in severity of trauma that did not involve the head and neck, number of body regions injured, mechanism of injury, or incidence of surgery after injury.(2)
In geriatric patients a satisfactory anaesthetic course requires an anaesthetic plan compatible with the patient physical status, adequate monitoring and careful perioperative attention. Basically, there is no best anaesthetic agent or technique for the elderly. Prospective and retrospective studies did not show differences between regional and general anaesthetic techniques. The anaesthetic plan for the elderly should, however, acknowledge the effect of age on anaesthetic requirements. Sensitivity of the cerebral cortex to opioids and benzodiazepines appears to increase with advancing age. Dosage of hypnotics, narcotics or sedatives should be reduced by 20 to 40% in elderly patients. Increased use of remifentanil and cisatracurium that do not require organ-based elimination clearance for the termination of their clinical effects will, also, facilitate predictable recovery in older patients.(3)
Prolonged postoperative cognitive dysfunction (POCD) may occur in geriatrics more than in adults, especially in those who are predisposed, through risk factors. Prolonged postoperative cognitive dysfunction followed certain types of major surgeries as cardiac operations carried under cardio-pulmonary bypass in the form of personality changes and memory impairment. Contributing factors might be preoperative cerebral dysfunction, hypothermia, intraoperative hypotension, loss of pulsatile flow and micro emboli of air or other matter affecting cerebral perfusion. Patients experiencing Prolonged postoperative cognitive dysfunction usually have primary cognitive decline or cognitive diseases as dementia. They may be under chronic treatment of B-blocking drugs. They may have been exposed to intraoperative hypoxia, hypercarbia, hypotension, hypothermia or hypoglycemia. (4)
Mortality was also increased in patients with complications, particularly cardiac complications and ventilator dependence. Cardiac and pulmonary complications were more frequent in patients who were more than 80 years of age, a fact that suggests a relationship among age, cardiopulmonary disease, and an unfavorable outcome. (5)