Autonomic and cardiovascular function in the geriatric patient

The elderly patient is at an increased risk for hemodynamic instability during anesthesia. The underlying mechanisms are primarily a decrease in the beta-receptor response to stimulation, stiffening of the connective tissue throughout the cardiovascular system, and increased vascular resistance during surgical stress and an increased dependency on cardiac filling. Unfortunately, the ability to maintain a steady preload diminishes with age and in general, changes in blood volume are buffered less effectively. Anesthetic management requires closer monitoring of blood pressure and a greater emphasis on vasomotor tone than on fluid administration when treating hypotension.