Clinical Medicine Reviews in Therapeutics

Anesthesiologists are faced with increasing numbers of elderly patients in their practice due to ageing population, especially in Western societies. Ageing is associated with physiologic changes that decrease the ability to respond to surgical and disease-related stress. Moreover, elderly patients suffer from significant co-morbidities including diseases of cardiovascular and pulmonary system. Both of these factors add to the challenges of anesthetic care in this patient population. Lastly, chronological age alone is an inadequate predictor of the response expected in an individual patient (the paradox of the “old” 65 year-old vs. a “young” 85 year -old patient). In our review we discuss the physiologic changes of ageing and write about most frequent or significant co-morbidities of old age and their effects on the anesthetic choice. We further review sedative and anesthetic agents, pain medications and other adjunct medications, which may result in important, potentially detrimental consequences for the elderly patient.