The elderly outpatient: current anesthetic implications

The present overview describes recent contributions to the literature with regard to choice of anesthetic techniques, approaches to anesthetic management of elderly outpatients undergoing arthroscopy and other procedures, reconsideration of the problem of postoperative delirium in the elderly patient, and a general summary of perioperative management and assessment of anesthetic risk in older adults.

Major advances in monitoring technology, pharmacology, and comprehensive preoperative assessment have reduced the probability of major adverse outcomes for geriatric surgical patients to low levels. Therefore, it has become difficult to demonstrate clear-cut superiority for any specific anesthetic agent or approach. Nevertheless, the need for prompt and complete recovery of consciousness and rapid discharge after surgery presents additional challenges for the anesthesiologist who is caring for elderly outpatients with regard to prompt recovery of cognitive function and suppression of nausea and vomiting.

The efficiency and speed with which outpatient surgery and anesthetic recovery can be conducted in older adults continue to improve. Monitors of depth of anesthesia, ultra-short-acting agents, and combined techniques have minimized minor complications such as nausea and vomiting, and have improved the speed with which these patients recover from anesthesia. A small proportion of elderly surgical outpatients remain at risk for residual postoperative cognitive dysfunction.