Anaesthesia in the older patient

Clinical anaesthesia and analgesia address a growing number of elderly surgical patients. Ageing modifies physiology, pharmacokinetics and pharmacodynamics, and comorbidity is a common occurrence in the elderly. Therefore, based on recent information regarding perioperative outcome, indications and techniques should be individualized.

Clinical studies have highlighted the occurrence of postoperative cognitive dysfunction in elderly patients, and have given some information on its risk factors. As pain was found to be one of the most important of these, this review is also focused on the management of perioperative pain. Recently published studies have compared epidural analgesia and parenteral analgesics; others have described the handling of parenteral opioids for postoperative analgesia in elderly patients, and the opioid-sparing effect of multimodal analgesia.

Postoperative cognitive dysfunction (POCD) is quite frequent. If late POCD seemed not related to the type of anaesthesia and analgesia provided, early POCD (interval delirium) was found to be related to perioperative haematocrit and transfusion requirement and to postoperative pain. Epidural analgesia using local anaesthetics and/or opioids was found to be probably better than parenteral opioids for the control of postoperative pain and the prevention of postoperative morbidity and mortality. However, well implemented protocols of parenteral analgesics could be nearly as efficient.