Choice of Anesthesia for Geriatric Patients

Pharmacologic Aspects of Aging: A Survey of the Effect of Increasing Age on Drug Activity in Adults

“…The decline of the cardiovascular system (decreased cardiac reserve and regional blood flow, and increased circulation time) (19, 21, 24–27, 30, 38) may contribute to an altered and delayed distribution of the drug as well as a delay in its elimination. In the case of volatile general anesthetics, respiratory changes with age (7, 25–27, 29) greatly affect the induction and duration of anesthesia, and other alterations (cardiovascular and renal) affect the tolerance of the patient to the anesthetic (41, 42).…”

“…Because of the variability of the aging process and because we are limited for the most part to cross‐sectional comparisons, studies in man are dependent upon data obtained on large numbers of subjects; the extrapolation of average results to the individual is virtually impossible except to provide a basis for initiating a therapeutic regimen. With respect to drug therapy in geriatric patients, extreme caution should be used, and the therapeutic schedule should be based on the previous drug history of the patient and a thorough knowledge of the pharmacology of the drug in question (41, 48). Individualism is an absolute necessity (8, 49).…”

“…This section, as well as those that follow, is divided generally into various classifications of drugs as determined by their basic mechanism and primary site of action. For instance, the subject of anesthesia, which has been fully reviewed elsewhere with respect to the geriatric patient (40–42, 65–69), is not discussed here as a whole, because of the different activities of the drugs used, i.e., general anesthetics, hypnotics, analgesics, and muscle relaxants. A compound such as amphetamine, though a potent analeptic (d‐isomer), is not discussed in this section, but is discussed as a drug which acts on the peripheral nervous system because it (d‐isomer) possesses good pressor activity and is a synthetic sympathomimetic (adrenergic) amine.…”

“…Since the older patient is more susceptible to anoxia because of vascular changes in the brain and heart (70), and because respiratory function is sufficiently altered, the administration of anesthetic gases or vapors may impose a dangerous stress in the elderly patient (41). Although there is some disagreement on the specific use of some anesthetic agents, generally these agents may be administered safely when caution is applied.…”

“…Despite these difficulties, if insults to tissue and prolonged administration are avoided, successful anesthesia can be achieved (3). This subject is covered in much greater detail elsewhere (40–42, 64–69).…”