Perioperative management of elderly surgical patients under general anesthesia

ABSTRACT

The perioperative care of the geriatric patient is complex. Older patients are at increased risk for complications due to a decreased functional reserve, variable response to stress, and the number of their comorbidities. These make it difficult to adequately assess the patient's ability to respond to the specific stresses associated with surgery. Normal aging results in changes in cardiac, respiratory, hepatic and renal physiology, and the response of the elderly patient to surgical stress is often unpredictable. The pharmacokinetics and pharmacodynamics of elderly and younger patients also differ and the elderly patient's use of multiple medications may alter homeostatic mechanisms. Developing comprehensive understanding of the perioperative care of the elderly patient undergoing general anesthesia could improve outcomes and might have particular value in patient care, especially with regard to pain management and the prevention of postoperative complications. Recently, the aim of surgery for elderly patients has become improving the quality of life rather than simply maintaining survival, so understanding of perioperative care of the elderly who have undergone general anesthesia has become essential for patient management.