[The respiratory system and the elderly: anesthetic implications.].

BACKGROUND AND OBJECTIVES Respiratory complications are responsible for a major number of elderly deaths after surgical procedures. Aging entails an important decrease in respiratory system functional reserves, while an increasing number of elderly people are being submitted to increasingly complex procedures. This study is a review of the respiratory system during aging and of anesthesia-induced changes in the elderly, emphasizing preoperative evaluation of respiratory function, postoperative pulmonary complications and details of anesthetic management. CONTENTS Physiologic respiratory changes due to aging are presented, with emphasis in pulmonary volume and capacity abnormalities, respiratory mechanics and gas exchange provided by anesthesia. Perioperative pulmonary mortality and morbidity in elderly patients are addressed, emphasizing the importance of appropriate preoperative evaluation, from stress tests to specific tests, to quantify pulmonary functional reserves. Appropriate anesthetic techniques for the elderly are discussed. CONCLUSIONS Aging brings about several respiratory system changes. Evidences have shown that, even in the absence of pulmonary disease, advanced age is a risk factor for postoperative pulmonary complications. It is necessary a thorough evaluation of preoperative respiratory function, adequate anesthetic management and specific postoperative care.