Regional anesthetic management of elderly patients

ABSTRACT

In general, elderly patients are less able to respond to perioperative stress and are more likely to suffer from postoperative complications and even death because of the decline in their functional organ reserve. Although no definitive evidence indicates that regional anesthesia is superior to general anesthesia in terms of the long-term prognosis in the elderly, regional anesthesia appears to be beneficial in many ways because it reduces bleeding during surgery, the stress response, and the incidence of thromboembolic complications, as well as facilitating excellent postoperative pain control. However, some issues specific to the elderly should also be considered. Age-related anatomical changes in elderly patients may make it difficult to perform epidural and spinal anesthesia, and physiologic and pharmacodynamic responses to local anesthetics may change with age. Elderly patients also show a greater extent of sensory and motor block, and are at a greater risk of hypotension after epidural and spinal block. In order to provide optimal anesthetic care and to facilitate a rapid recovery and improved outcomes in elderly patients, clinicians must have a better understanding of age-related changes when regional anesthesia is administered. Additionally, tailored anesthetic techniques should be used, as well as good perioperative care, in accordance with the type of surgery and the individual physical status of elderly patients.