Extremities are positioned carefully to avoid injury. Patients with spinal curvature or limited motion need padding placed in a manner that distributes pressure over as large an area as possible, avoiding small pressure points. Arthritic changes can make positioning and intubation difficult. Monitoring Intraoperative monitoring of blood pressure, heart rate and rhythm, ventilation, fluid status, and urinary output is similar in patients of all ages. For frail patients with fragile skin, the blood pressure cuff should be applied with care, using a thin layer of cotton undercast padding to protect the skin if needed.
Oxygen saturation is monitored with a pulse oximeter, typically placed on the finger.
However, the signal quality at this site may be inadequate because of decreased pulsatile flow in the elderly. If quality is inadequate, the probe can be placed on the earlobe. Anesthetics or sedatives should be administered only if an accurate pulse oximeter reading is obtained. In many elderly patients, core body temperature is lower and more difficult to maintain than in younger patients. Therefore, specific intraoperative measures are required to maintain a reasonable body temperature.