Anesthetic Management and Perioperative Risks in the Geriatric Population
DOI:
https://doi.org/10.69760/portuni.26050004Keywords:
Geriatric anesthesia, perioperative complications, postoperative delirium, postoperative cognitive dysfunction, frailty, polypharmacy, homeostenosis, prehabilitation, regional anesthesiaAbstract
The increasing frequency of surgical interventions in the elderly population poses significant challenges in modern anesthesiology, requiring a highly specialized clinical approach. Anesthetic risks in older patients are not merely a function of chronological age but are fundamentally linked to the depletion of physiological reserve and structural involution within vital organ systems. Aging leads to increased vascular rigidity and decreased myocardial compliance, significantly elevating the likelihood of intraoperative hemodynamic instability and myocardial infarction. In the respiratory system, the loss of lung elasticity and weakened protective airway reflexes heighten the risk of postoperative pneumonia and respiratory failure. Perhaps the most concerning complication is related to the central nervous system: postoperative delirium, characterized by acute confusion, affects approximately 15–50% of elderly patients, leading to prolonged hospitalization and increased mortality. Furthermore, age-related declines in hepatic and renal function impair the clearance of anesthetic agents, increasing the risk of drug toxicity and delayed emergence from anesthesia. The prevalence of comorbidities—diabetes, hypertension, and dementia—combined with polypharmacy, complicates the pharmacological profile and increases the potential for dangerous drug interactions. To mitigate these risks, meticulous preoperative assessment is essential, following the “start low, go slow” principle in drug titration. Preference is often given to regional anesthesia over general anesthesia when feasible to preserve cognitive function and reduce systemic stress. Ultimately, successful anesthesia in the elderly is an intricate balance of maintaining fragile homeostasis while managing the multifaceted physiological decline inherent in aging, requiring a multidisciplinary strategy for optimal outcomes.
References
Aldecoa, C., Bettelli, G., Bilotta, F., Sanders, R. D., Audard, V., Borozdina, A., Cherubini, A., Jones, C., Kehlet, H., MacLullich, A., Radtke, F., Riese, F., Slooter, A. J., Veyckemans, F., Kramer, S., Neuner, B., Weiss, B., & Spies, C. D. (2017). European Society of Anaesthesiology evidence-based and consensus-based guidelines on postoperative delirium. European Journal of Anaesthesiology, 34(4), 192–214. https://doi.org/10.1097/EJA.0000000000000594
American Society of Anesthesiologists. (2022). Practice guidelines for perioperative blood management: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology, 136(1), 11–54. https://doi.org/10.1097/ALN.0000000000003945
Carli, F., & Scheede-Bergdahl, C. (2015). Prehabilitation to enhance perioperative care. Anesthesiology Clinics, 33(1), 17–33. https://doi.org/10.1016/j.anclin.2014.11.002
Chou, R., Gordon, D. B., de Leon-Casasola, O. A., Rosenberg, J. M., Bickler, S., Brennan, T., Carter, T., Cassidy, C. L., Chittenden, E. H., Degenhardt, E., Griffith, S., Manworren, R., McCarberg, B., Montgomery, R., Murphy, J., Perkal, M. F., Suresh, S., Sluka, K., Strassels, S., & Wu, C. L. (2016). Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain, 17(2), 131–157. https://doi.org/10.1016/j.jpain.2015.12.008
Crosby, G., & Murphy, M. F. (2023). Anesthetic management in the elderly. In R. D. Miller (Ed.), Miller’s anesthesia (9th ed., pp. 1820–1851). Elsevier.
Devereaux, P. J., & Sessler, D. I. (2015). Cardiac complications in patients undergoing major noncardiac surgery. New England Journal of Medicine, 373(23), 2258–2269. https://doi.org/10.1056/NEJMra1502824
Griffiths, R., Alper, J., Beckingsale, A., Goldhill, D., Heyburn, G., Holloway, J., Leaper, E., Parker, M., Ridgway, S., White, S., Wiese, M., & Wilson, I. (2014). Management of proximal femoral fractures 2011: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia, 67(1), 85–98. https://doi.org/10.1111/j.1365-2044.2011.06957.x
Guay, J., Choi, P. T., Suresh, S., Albert, N., Kopp, S., & Pace, N. L. (2016). Neuraxial blockade for the prevention of postoperative mortality and major morbidity: An overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews, 1, CD010108. https://doi.org/10.1002/14651858.CD010108.pub2
Hall, D. E., Arya, S., Schmid, K. K., Blaser, C., Nagpal, S., Couch, M. E., & Kennedy, J. (2019). Association of a frailty screening initiative with postoperative survival at 30, 180, and 365 days. JAMA Surgery, 154(7), 631–640. https://doi.org/10.1001/jamasurg.2019.0532
Inouye, S. K., Bogardus, S. T., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney, L. M. (2000). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340(9), 669–676. https://doi.org/10.1056/NEJM199903043400901
Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911–922. https://doi.org/10.1016/S0140-6736(13)60688-1
Kirmeier, E., Eriksson, L. I., Lewald, H., Jonsson Fagerlund, M., Hoeft, A., Hollmann, M., Meistelman, C., Hunter, J. M., Ulm, K., & Blobner, M. (2019). Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): A multicentre, prospective observational study. The Lancet Respiratory Medicine, 7(2), 129–140. https://doi.org/10.1016/S2213-2600(18)30294-7
Miller, R. D., Cohen, N. H., Eriksson, L. I., Fleisher, L. A., Wiener-Kronish, J. P., & Young, W. L. (Eds.). (2020). Miller’s anesthesia (8th ed.). Elsevier.
Monk, T. G., & Price, C. C. (2011). Postoperative cognitive disorders. Current Opinion in Critical Care, 17(4), 376–381. https://doi.org/10.1097/MCC.0b013e328348bef9
O’Sullivan, K. E., Byrne, J. S., Mohammed, N., McHugh, T. J., Hennessy, M. J., & Dowd, J. F. (2017). Similar early outcomes for laparoscopic versus open left hemicolectomy. Journal of Laparoendoscopic & Advanced Surgical Techniques, 27(4), 370–374. https://doi.org/10.1089/lap.2016.0421
Pearse, R. M., Harrison, D. A., MacDonald, N., Gillies, M. A., Blunt, M., Ackland, G., Grocott, M. P., Ahern, A., Griggs, K., Scott, R., Hinds, C., & Rowan, K. (2014). Effect of a perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery. JAMA, 311(21), 2181–2190. https://doi.org/10.1001/jama.2014.5305
Priebe, H. J. (2017). Perioperative myocardial infarction: Aetiology and prevention. British Journal of Anaesthesia, 95(1), 3–19. https://doi.org/10.1093/bja/aei049
Radtke, F. M., Franck, M., Lendner, J., Krüger, S., Wernecke, K. D., & Spies, C. D. (2013). Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. British Journal of Anaesthesia, 110(Suppl 1), i98–i105. https://doi.org/10.1093/bja/aet055
Sessler, D. I. (2016). Perioperative thermoregulation and heat balance. The Lancet, 387(10038), 2655–2664. https://doi.org/10.1016/S0140-6736(15)00981-2
Sessler, D. I., Bloomstone, J. A., Aronson, S., Berry, C., Gan, T. J., Kellum, J. A., Plumb, J., Mythen, M. G., Grocott, M. P. W., Edwards, M. R., & Miller, T. E. (2019). Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. British Journal of Anaesthesia, 122(5), 563–574. https://doi.org/10.1016/j.bja.2019.01.013
Shafer, S. L. (2019). Pharmacokinetics and pharmacodynamics of anesthetic drugs. In R. D. Miller (Ed.), Miller’s anesthesia (8th ed., pp. 432–472). Elsevier.
Valizadeh, S., Mammadova, M., & Ganbarli, S. (2025). Management of gastric hemorrhage in intensive care patients: Pathophysiology, diagnosis, and treatment. Journal of Clinical Medicine Research.
Valizada, S., Hasanova, S., Huseynova, S., & Mammadova, M. (2025). Symptoms, complications and statistical indicators of diabetes mellitus among the residents of the Nakhchivan Autonomous Republic for 2024. Medical Research Journal.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows others to share, adapt, and build upon the work for any purpose, provided appropriate credit is given to the original author(s) and source. Authors are permitted to enter into separate agreements for non-exclusive distribution of the published version (e.g., post to a repository or publish in a book), with acknowledgement of its initial publication in this journal.
