Unique Aspects of the Elderly Surgical Population: An Anesthesiologist's Perspective

Abstract

Increasing life expectancies paired with age-related comorbidities have resulted in the continued growth of the elderly surgical population. In this group, age-associated changes and decreased physiological reserve impede the body's ability to maintain homeostasis during times of physiological stress, with a subsequent decrease in physiological reserve. This can lead to age-related physiological and cognitive dysfunction resulting in perioperative complications. Changes in the cardiovascular, pulmonary, nervous, hepatorenal, endocrine, skin, and soft tissue systems are discussed as they are connected to the perioperative experience. Alterations affect both the pharmacodynamics and pharmacokinetics of administered drugs. Elderly patients with coexisting diseases are at a greater risk for polypharmacy that can further complicate anesthetic management. Consequently, the importance of conducting a focused preoperative evaluation and identifying potential risk factors is strongly emphasized. Efforts to maintain intraoperative normothermia have been shown to be of great importance. Procedures to maintain stable body temperature throughout the perioperative period are presented. The choice of anesthetic technique, in regard to a regional versus general anesthetic approach, is debated widely in the literature. The type of anesthesia to be administered should be assessed on a case-by-case basis, with special consideration given to the health status of the patient, the type of operation being conducted, and the expertise of the anesthesiologist. Specifically addressed in this article are age-related cognitive issues such as postoperative cognitive dysfunction and postoperative delirium. Strategies are suggested for avoiding these pitfalls.

Keywords: elderly physiological changes; geriatric anesthesiology; geriatric surgery; operation considerations.

Figure 1.

Pressure volume curves in a 20-year-old (upper panel) and 60-year-old (lower panel). As age increases, there is an increase in lung compliance, residual volume, and functional residual capacity with a decrease in chest wall compliance. TLC indicates total lung capacity; FRC, functional residual capacity; RV, residual volume.

Figure 2.

Forced vital capacity (FVC) and forced expiratory volume (FEV₁) among males (M) and females (F). The aged individual has reductions in FVC and FEV_1.

Figure 3.

Expiratory flow rate curve in younger and older subjects. TLC indicates total lung capacity; RV, residual volume. Young is between the ages 20 and 49 and old is between the ages 50 and 84.