Anesthetic Management of the Elderly Patient with Heart Disease

The above material is presented in an effort to give the clinician the basic knowledge necessary to care for the elderly patient with heart disease. It is important to remember that the anesthetic technique is not meant to cure the patient. Often it is optimal to leave the patient at hemodynamic baseline, if they are stable, rather than try to manipulate the patient's hemodynamic profile to a more acceptable value. This maneuver may often result in hemodynamic deterioration of the patient. Additionally, other concerns may face the anesthesiologist when multiple valvular lesions, coronary artery stenoses and/or myocardial dysfunction all exist within the same patient. In this case, one must determine the predominant lesion, if any, which deserves primary attention. The pros and cons of each anesthetic intervention must be weighed and the response to each closely monitored. There are no magic formulas to guide management of these problems; rather, there are a constellation of tools which the clinician may utilize in order to provide optimal care.