Anaesthesia and the preparation and management of elderly patients undergoing surgery

Published:September 28, 2007DOI:


      With increasing life expectancy, the number of very elderly patients requiring surgery and anaesthesia is increasing. Age, co-morbidity and altered pharmacokinetics clearly need to be considered in assessment of surgical risk but even in the apparently well older person there is a loss of physiological reserve that may be overlooked on cursory examination. Cognitive impairment after surgery may seriously hinder older people. This paper looks at these factors in detail and provides some remedies.


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        • Prys-Roberts C.
        Isolated systolic hypertension: pressure on the anaesthetist?.
        Anaesthesia. 2001; 56: 505-510
      1. Looi YC. A review of the literature on postoperative pain in older cancer patients. Eur J Cancer [in this issue].

        • Marcantonio E.R.
        • et al.
        The relationship of postoperative delirium with psychoactive medications.
        JAMA. 1994; 272: 1518-1522
        • Duggleby W.
        • et al.
        Cognitive status and postoperative pain: older adults.
        J Pain Symptom Manage. 1994; 9: 19-27
        • Moller J.T.
        • et al.
        Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction.
        Lancet. 1998; 351: 857-861
        • Mandal P.K.
        • Pettegrew J.W.
        • McKeag D.W.
        • Mandal R.
        Alzheimer’s disease: halothane induces Abeta peptide to oligomeric form–solution NMR studies.
        Neurochem Res. 2006; 31: 883-890
        • Abildstrom H.
        • Rasmussen L.S.
        • Rentowl P.
        • et al.
        Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction.
        Acta Anaesthesiol Scand. 2000; 44: 1246-1251
        • Fodale V.
        • et al.
        Alzheimer’s disease and anaesthesia: implications for the central cholinergic system.
        Br J Anaesth. 2006; 97: 445-452
        • Lee T.H.
        • et al.
        Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.
        Circulation. 1999; 100: 1043-1049
        • Girish M.
        Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery.
        Chest. 2001; 120: 1147-1151