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Anaesthesia for the elderly outpatient: preoperative assessment and evaluation, anaesthetic technique and postoperative pain management

Bettelli, Gabriellaa,b,c

Current Opinion in Anaesthesiology: December 2010 - Volume 23 - Issue 6 - p 726–731
doi: 10.1097/ACO.0b013e3283400b6c
Ambulatory anesthesia: Edited by Jan G. Jakobsson

Purpose of review: Epidemiological data show a continuous expansion of elderly population, associated with an increased demand for surgical treatments by older patients. Geriatric anaesthesia is emerging as a new subspecialty. Outpatient anaesthesia for elderly patients requires greater specific knowledge and skills. Given the high economic and social pressure, anaesthetists will be requested to treat an increasing number of elderly as outpatients.

Recent findings: Functional status as a criterion for preoperative assessment of older patients has been introduced in the last years. In comparison to inpatient, outpatient setting seems to reduce the risk of postoperative cognitive disorders after surgery. Heart failure has shown to be an important risk factor of perioperative complication and death in the elderly; when more than mild, it contraindicates day surgery. Drug-eluting stents, which require a double antiaggregative therapy for 12 months after positioning, formally exclude patients from day surgery for that period. Sedation as a part of Monitored Anaesthesia Care (MAC) has shown to be potentially dangerous, due to increased risk of hypoxic complications and increased likelihood of cognitive disturbances. Effective postoperative pain treatment after geriatric day surgery requires careful pain assessment and drug titration. In the future, the development of telematic communication systems will extend indications.

Summary: Recent findings contribute to a better comprehension of the most important specificities of elderly patients undergoing day surgery and provide basic elements for a safe perioperative management in the outpatient setting.

aDepartment of Geriatric Surgery, Italy

bDepartment of Anaesthesia, Analgesia, Day Surgery and Intensive Care, Italy

cINRCA – Italian National Research Centres on Aging, IRCCS, Ancona, Italy

Correspondence to Gabriella Bettelli, Director, INRCA – Italian National Research Centres on Aging, Via della Montagnola 81, 65123 Ancona, Italy Tel: +39 0718003400; e-mail: g.bettelli@inrca.it

© 2010 Lippincott Williams & Wilkins, Inc.