Anaesthesia and the elderly



Are there special considerations regarding the elderly having anaesthesia?

Elderly patients differ from younger patients in numerous ways and this affects the way the anaesthesia is administered the possible complications and problems that may occur during and after surgery. Elderly patients are at an increased risk of illness or disease and death associated with anaesthesia and surgery (Oxford Handbook).
Elderly patients have a higher prevalence of certain medical conditions and co-morbidity (multiple conditions). These include heart disease, cerebrovascular disease (stroke), hypertension (high blood pressure) and kidney impairment. This impacts on the conduct of the anaesthesia, medication doses and care of the patient post-operatively. Elderly patients also may be taking medications that will need careful review to ensure they do not interact with the anaesthetic drugs. Patients with significant heart disease will require monitoring in a high dependency or intensive care unit. They will require review by a heart specialist prior to having surgery.
Surgery has a major physiological impact in the body in terms of stress response. In elderly patients, these responses may have a significant impact. For example, the increased release of adrenaline increases the workload of the heart. The blood becomes stickier. For patients with underlying heart disease who have narrowed coronary arteries, it may be detrimental to make the heart work harder.
The elderly have lower requirements for narcotic analgesics and sedatives and are more susceptible to depression of conscious level and breathing. (Oxford Handbook)
Temperature regulation is impaired making the elderly more prone to hypothermia (cold temperature). Postoperative hypothermia causes shivering, increasing work on a potentially over-worked heart, putting the patient at risk of suffering a heart attack.
The immune system in elderly patients also is not as effective as in the younger population. This makes the elderly more prone to hospital-acquired and surgical infections. The elderly are also at a higher risk of postoperative confusion. Some of the causes may be reversible, however in a small percentage of patients the confusion persists long term (greater then one year).
Your anaesthetist is trained to anticipate, detect and treat all these issues.

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