[Limitations of anesthesia. Risks and older patients in daily practice]

The demographic development and ongoing improvement of surgical techniques result in an increasing number of high risk elderly patients undergoing surgery. The anesthesiologist has an important role within the management of these patients, because apart from the present illness resulting in a surgical intervention the anesthesiologist has to assess and treat the pre-existing medical disorders in the perioperative period. In many cases the pre-existing medical disorders and the medications needed for their treatment are more important within the anesthesiological management than the operation to be performed. Apart from the preoperative assessment of the patients risk in combination with a possible optimization of the therapy of the comorbidities, the intra- and postoperative management of these high risk patients has an important influence on the postoperative rehabilitation of these patients. The adequate perioperative anesthesiological management can result in the avoidance of intensive care treatment. A very often underestimated topic is the sufficient perioperative pain treatment of these high risk elderly patients.