Practical Management of Anaesthesia in the Elderly

The elderly population is rapidly growing and particularly diverse. Ageing leads to reduced organ function and a decline in physiologic reserve. Elderly patients are characterised by great inter-individual variability in physiological function with a high prevalence of chronic disease. In general, older patients have a higher risk of postoperative adverse outcomes, and frailty is a very important risk factor. This review article aims to provide a practical guide to anaesthetic management of the elderly surgical patient. To optimise care, clinicians should be familiar with the typical physiologic changes related to ageing and the implications for anaesthetic management. All anaesthetic techniques, methods and agents can be applied, if tailored to the patient’s physiologic and pathologic changes. The elderly are more sensitive to anaesthetics, meaning that desired sedative and analgesic effects are reached at lower doses compared with younger patients, and the haemodynamic depressing side effects of anaesthetics are often more pronounced. To reduce the risk of circulatory collapse, the clinician should carefully titrate anaesthetics and await the response with patience. The dose of neuromuscular blocking agents should rarely be reduced for intubation, but the duration of action of neuromuscular blocking agents is often prolonged and difficult to predict. Perioperative neuromuscular monitoring is therefore strongly recommended. In the postoperative period, prevention of avoidable morbidity and functional decline is crucial; comprehensive multidisciplinary care and multimodal interventions may facilitate earlier recovery and decrease the risk of complications.