38 - The Geriatric Patient: Age-Related Pathophysiologic Changes and Anesthesia Considerations

Abstract

Human populations across the world are aging at an increasing rate. Concurrent with this is a trend toward performing an increasing number of neurosurgical procedures in patients older than 65 years of age. The physiologic processes of aging on various organ systems together with chronic medical conditions (e.g., cardiovascular disease, stroke, dementia, and diabetes) and the chronic effects of modern lifestyles (e.g., smoking and obesity) place elderly patients at higher risk for complications during the perioperative phase. Thus it is important to have an awareness of these factors and evidence-based recommendations on how to modify anesthetic and perioperative practices for geriatric neurosurgical patients to avoid common perioperative complications and improve outcomes such as survival and functional independence. In this chapter, we summarize some of the known physiologic age-related changes in vital organ systems with a focus on neuroanesthetic practice. We also detail common ways to optimize the intraoperative care of geriatric neurosurgical patients during some of the more commonly performed surgeries in this group before finally commenting on specific postoperative concerns for geriatric neurosurgical patients.