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Anesthesia for the older adult

Sheila Barnett, MD
Section Editor
Girish P Joshi, MB, BS, MD, FFARCSI
Deputy Editor
Nancy A Nussmeier, MD, FAHA


Older adults (≥65 years of age) account for a disproportionately large fraction of all surgical procedures performed in the United States (figure 1) [1,2]. Older age is a risk factor for perioperative mortality, but preoperative comorbidity and invasiveness of the surgical procedure are other important predictors of mortality in this age group [3-9]. The American Society of Anesthesiologists (ASA) Physical Status score (table 1) [10], indicating severe systemic disease, is an established predictor of adverse outcomes after surgery in patients of all ages but does not specify age as a factor [3-6].

This topic will discuss age-related physiologic changes that affect anesthetic drugs and techniques, optimal perioperative anesthetic management, and risk factors for complications in older patients.


Aging is associated with a progressive loss of functional reserve in all organ systems (see "Normal aging"). However, there is considerable individual variability in the onset and extent of these changes. Nevertheless, even the healthy older adult has reduced physiologic reserve, and organ systems may be compromised during illness and/or surgical stress. The following physiologic changes specifically impact anesthetic care, in large part by increasing susceptibility to anesthetic drugs [11].

Nervous system — Age-related changes in the central and peripheral nervous system affect the older adult's response to anesthetics and other medications, as well as the perception of pain.

Central nervous system changes include reduction in brain size and neuronal density and widening of the sulci and ventricles. Regional reductions in neurotransmitters (eg, dopamine, serotonin, and acetylcholine) and neuroreceptors may occur [12].

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Literature review current through: Nov 2017. | This topic last updated: Nov 16, 2017.
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