DRUGS IN ANESTHESIA: Edited by Klaus HahnenkampThe aging brain and anesthesiaBrown, Emery N.a,b,c; Purdon, Patrick L.aAuthor Information aDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts bInstitute for Medical Engineering and Science cDepartment of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA Correspondence to Dr Emery N. Brown, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, GRB 444, 55 Fruit Street, Boston, MA 02114, USA. Tel: +1 617 726 7487; fax: +1 617 324 1884; e-mail: [email protected] Current Opinion in Anaesthesiology: August 2013 - Volume 26 - Issue 4 - p 414-419 doi: 10.1097/ACO.0b013e328362d183 Buy Metrics Abstract Purpose of review To review the neurophysiology and neuroanatomy of normal aging and the recent recommendations for the clinical management of general anesthesia and sedation in the elderly. Recent findings As the population ages, the number of elderly patients having surgery is likewise increasing and with it, the prevalence of postoperative cognitive disorders. Postoperative cognitive disorders including delirium and postoperative cognitive dysfunction are common postanesthesia complications in elderly patients. Several risk factors for postoperative disorders have been identified, and anesthesiologists commonly adapt their practice habits when taking care of elderly patients to try to mitigate the effects of the anesthetics on postoperative cognitive function. These practices are reasonable and prudent; yet, they are not well supported by an understanding of the aging brain and specifics of how the anesthetic effects on the brain change with age. Through functional imaging and electrophysiological studies, much is being learned about the neurophysiology and the neuroanatomy of normal aging. Summary Our analysis suggests that understanding the neurophysiology and neuroanatomy should be part of the standard working knowledge of anesthesiologists and that this knowledge can guide their use of the electroencephalogram to track more accurately the brain states of elderly patients receiving anesthesia care. © 2013 Lippincott Williams & Wilkins, Inc.