Anaesthesia for the patient with dementia undergoing outpatient surgery

PURPOSE OF REVIEW: Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both regarding anaesthesia and other aspects that should be considered to ensure a quick and uncomplicated recovery. RECENT FINDINGS: Demented patients often receive prescribed medication that can interact with various anaesthetic drugs and cause serious side effects. The anaesthesiologist should consider this when choosing the drugs used during surgery and when relieving postoperative pain. Generally, hypnotics, opioids, and inhalational anaesthetics should be administered in lower doses and carefully titrated because of altered pharmacokinetics and pharmacodynamics leading to a great variability, as documented in elderly patients. Neuromuscular blocking agents, and especially rocuronium, display an increased variability in the duration of action, but the new drug sugammadex may reverse the neuromuscular block in a few minutes. Postoperative cognitive decline is more frequent in elderly patients with preexisting cognitive impairment and several preventive measurements can be provided. SUMMARY: Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications.