Anesthesia for the elderly: selected topics.
OBJECTIVE
With the graying of the Western population, there is a continuous increase in the proportion of elderly patients undergoing surgical procedures. Geriatric anesthesia is emerging from a 'subspecialty' to the mainstream of today's anesthesia and perioperative care. Much has been written on anesthesia for the elderly, but this review will concentrate on selected topics related to elderly care that represent current unresolved and pertinent issues for the care of the elderly surgical patient.


RESULTS
Postoperative cognitive dysfunction, cardiac diastolic dysfunction and prophylactic perioperative beta-blockade in the process of major noncardiac surgery are three main topics that have recently attracted great interest in clinical practice and research, and have therefore been chosen as the selected topics for this current review.


CONCLUSIONS
Although age is a clear risk factor for postoperative cognitive dysfunction, the association of general anesthesia with cognitive dysfunction is less clear, as is the effect of anesthesia per se or surgery on long-term cognitive dysfunction. Cardiac diastolic dysfunction is a relatively new and evolving concept in anesthesia and perioperative medicine, yet clearly diastolic dysfunction even with a normal ejection fraction may have a significant effect on the perioperative outcome and management of elderly patients. Small, but powerful studies have shown significant outcome benefit with prophylactic perioperative beta-blockade in high-risk patients undergoing major noncardiac surgery. Data from other studies, however, are still conflicting and the final verdict awaits larger scale outcome studies.
Levine
Wilton C
WC
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts 02114-2696, USA.
Mehta
Vipin
V
Landesberg
Giora
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000768:Anesthesia, General / Q000009:adverse effects; D003072:Cognition Disorders / Q000139:chemically induced; D003971:Diastole / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists