Perioperative care of the elderly

and half will undergo surgery within the remainder of their lifetime. There are few anaesthetic techniques that are used in younger adults that cannot be used to anaesthetise the elderly patient.However, even in the absence of a specific organ-based disease process, anaesthesia for the elderly may require an alteration in technique to take account of age-related changes to normal physiology. It is vital to consider the effects that the ageing process, the active disease process and any residual effects of previous illness have had on the elderly patient and tailor the anaesthetic technique accordingly. The following comments relate to elective elderly patients, or emergency patients who have been appropriately resuscitated after admission. There are very little data to support the attempt to achieve optimal resuscitation using assessment of cardiac output and oxygen delivery. Several studies with small numbers of patients have been quoted, but the veryheterogeneous nature of the elderly makes extrapolation from these difficult. Careful preoperative assessment is essential in the elderly and this has been described in a previous article published in this journal (see key references).