[Anesthesia related physiologic and pharmacologic changes in the elderly].

Abstract

The importance of geriatric patients is growing with the increasing number of people over the age of 65 and with the higher percentage of surgical interventions. Multiple physiological changes in the cerebrovascular, cardiovascular, respiratory, renal and hepatic system, and pharmacological changes such as a reduction in hydrophilic distribution and metabolism cause increased drug sensitivity, a reduced elimination rate and prolonged duration of action. Pre-existing diseases correlate with an increased rate of complications such as hypoxia, hypothermia and cardiovascular, pulmonary, cerebral or renal complications, the highest incidence of which occurs on the first and between the third and fifth postoperative days. To reduce the incidence of these complications, a thorough pre-anaesthetic examination and optimization of the patient's condition is recommended. Hypovolaemia or too intense premedication should be avoided. In cardiac-risk patients, a beta-adrenergic blockade is necessary. Purely regional anaesthesiological techniques should be used as they reduce one-month mortality by a third and morbidity by up to 59%. For general anaesthesia, preoxygenation and careful titration of the drugs used help to achieve cardiovascular stability. Institutionalized postanaesthetic standards help to avoid an aggravation of the patient's condition due to shivering, hypothermia or postoperative pain.