Nonoperating room anaesthesia for elderly patients

The number of elderly patients receiving non-operating room anaesthesia (NORA) has substantially increased because of clinical, epidemiological, social and economic reasons. Considering the high risk of anaesthesia-related adverse events in this population, along with the limitations of NORA, more specific knowledge and skills are required.

Advanced age appears to be an independent risk factor for anaesthesia-related adverse events in a NORA setting, similar to the traditional operating room. As significant changes occur in the pharmacological effects of anaesthetic agents with aging, reducing dosage and carefully titrating drugs are essential. Because NORA-related injury is frequently related to airway obstruction/respiratory depression, non-invasive respiratory activity monitoring is more useful for sedation of elderly patients. Additionally, advanced age increases the risk of aspiration and cognitive complications, even during sedation.

Elderly patients may greatly benefit from the lower invasiveness and faster recovery offered by interventional procedures. However, as they represent a highly heterogeneous population with large variations in physiological reserves and comorbidities, anaesthesiologists should strive to maintain the same practice standards throughout all anaesthetizing locations. Knowledge of the unique hazards associated with NORA in elderly patients may further enhance patient safety.Video abstract: NORA for elderly patients.mp4: http://links.lww.com/COAN/A66.