Implication of aging on anesthetic drugs.
OBJECTIVE
The elderly population is increasing in number each year, and more patients are presenting for anesthesia and surgery. One of the key areas for improving the care of the elderly is a better understanding of the influence of aging on drug pharmacokinetics and dynamics.


RESULTS
We now know more about the effects of risk factors on the occurrence of postoperative complications, and strategies to improve outcome after anesthesia and surgery. Two such strategies include the role of perioperative beta-adrenoceptor blockade in obtunding cardiovascular responses and myocardial ischaemia, and the provision of effective perioperative analgesia. Both topics have featured in key publications during the past year. Cognitive dysfunction following surgery occurs in about 10% of elderly patients; possible etiologies include a decline in central nervous system cholinergic function. One major disease of the elderly is Parkinson's disease, which offers challenges to the anesthesiologist both with regard to alterations of physiology and in choice of anesthetic drugs and techniques.


CONCLUSIONS
The effects of comorbidity and intercurrent medications may alter the normal anesthetic practice of the clinician's care of the elderly patient. Further studies in these key areas may lead to improved outcomes.
Sear
John W
JW
Nuffield Department of Anaesthetics, University of Oxford, Oxford, UK. john.sear@nda.ox.ac.uk