Gero-Anesthesia: Functional Reserve, Cardiovascular Changes, and Postoperative Complications

Abstract

The most-important recent advance in our understanding of the anesthetic implications of aging has been recognition of the need to distinguish clearly between processes of aging as opposed to age-related disease. Consequences of altered tissue and organ system structure and function that are universally observed in all elderly individuals and increase in severity or magnitude with advancing years reflect aging. On the other hand, changes in tissue structure or organ system function that are not seen in all members of a geriatric population, or those changes that do not increase in severity with advancing chronological age, are probably due to age-related disease. Even in healthy and fit older individuals, however, maximal levels of organ function decline more rapidly than do basal functional requirements. The difference between maximal and basal function defines the concept of functional reserve. Therefore, normal aging typically produces a progressive loss of organ system functional reserve (Fig. 1).