Anesthetic Management

Abstract

Elderly patients will constitute 20% of the population in the USA by 2030. This phenomenon has clear implications for healthcare including perioperative care. While this group consumes approximately 35% of the surgical services, their perioperative outcomes lag behind other age groups. While traditional anesthetic management focused in the intraoperative portion, it is peremptory to provide comprehensive and coordinated care along the perioperative continuum. In the preoperative phase, a systematic review of systems and comorbidities remains most important. However, the concepts of frailty as a determinant of outcomes and pre-habilitation in order to further optimize those presenting for anesthesia and surgery provide new perspectives in the care of these patients. Intraoperative, assuring organ perfusion, proper ventilation, and minimizing the physiological responses to surgery are key aspects. In addition prevention of awareness and movement are also important goals. Postoperatively, assessing and treating pain properly; avoiding, recognizing, and treating postoperative delirium; preventing falls; and assuring proper hydration and nutrition are important aspects in the management of these patients. The care of the surgical geriatric patient is complex and requires excellent coordination and communication across all healthcare providers involved in their care. The perioperative surgical home promotes such collaborative effort and has proven results in different surgical service lines. This approach might prove useful when caring for the older adult across all the phases of the perioperative continuum.