Anaesthesia and the elderly

As a result of age-related physiological changes and multi-comorbidity, which both result in reduced functional reserve of the organ systems, old patients are more vulnerable to surgical stress and perioperative impairment in organ functions. Therefore, the incidence of severe complications during the perioperative course is increased in the elderly. Regional anaesthesia or a combination of regional and general anaesthesia is considered to be beneficial in elderly patients, because neuraxial blockade may reduce sympathetic activation, and has been demonstrated to reduce postoperative mortality. Other protective strategies to maintain organ functions in elderly patients include medication with beta-blockers in patients with cardiovascular risks, the avoidance of hypothermia, the maintenance of systemic oxygen delivery, and patient-controlled pain therapy.