| Abstract: | With an ageing population, anaesthetists have increasing importance in taking care of the elderly undergoing surgery. Physiological changes, comorbidities, frailty and cognitive dysfunction conduce to adverse outcomes, institutionalization and mortality. This article looks into the physiological changes and anaesthetic considerations in the older patients. Preoperative assessment including use of the Comprehensive Geriatric Assessment, frailty, nutritional and cognitive assessments will be discussed. Prehabilitation can potentially modify frailty, improve outcome and reduce length of hospitalization. Preoperative nutritional therapy, where indicated, can improve nutritional status and reduce complications.Two important complications to avoid in the elderly are perioperative neurocognitive disorder (PND) and postoperative acute kidney injury (PO-AKI). PND is a predictor of poor outcome including mortality. Intraoperative electroencephalogram monitoring may help to decrease the incidence of delirium. PO-AKI is a common morbidity in elderly and its incidence can be reduced by appropriate fluid therapy and drug choice. |
