Safe delivery of anesthesia in older patients requires understanding of age-related physiological and pharmacological changes, along with careful preoperative optimization.
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May support local anaesthetic without sedation for minor procedures in older adults; leaves open optimal techniques pending prospective trials.
Older people are presenting in increasing numbers for surgical procedures. The anaesthetist must be aware of the physiological changes produced by ageing and the various age‐related disease processes coexisting in the elderly. Significant changes to the pharmacokinetics and pharmacodynamics of most of the commonly administered anaesthetic drugs occur in older people. This has a direct impact upon the safe delivery of anaesthesia in this patient population. Subcutaneous infiltration of local anaesthetic drugs without sedation is the anaesthetic technique of choice but is only appropriate in certain minor surgical procedures. Otherwise, no one anaesthetic technique has been demonstrated to be superior in the older patient. Anaesthesia may be successfully administered to older people provided the anaesthetist carefully evaluates and optimises the patient's medical condition prior to surgery, modifies the anaesthetic accordingly, and pays close attention to detail.
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Antony Leaver (1999) studied this question.
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