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Thoracic anesthesia in the elderly

Kozian, Alf; Kretzschmar, Moritz A.; Schilling, Thomas

Current Opinion in Anaesthesiology: February 2015 - Volume 28 - Issue 1 - p 2–9
doi: 10.1097/ACO.0000000000000152
THORACIC ANESTHESIA: Edited by Thomas Hachenberg and Moritz A. Kretzschmar

Purpose of review The mean age of patients presenting for thoracic surgery is rising steadily, associated with an increased demand for thoracic surgical treatments by geriatric patients. With increasing age, physiologic changes and comorbidities have to be considered. Thoracic anesthesia for elderly patients requires greater specific knowledge.

Recent findings Respiratory mechanics change progressively during aging, and the pharmacology of different drugs is also altered with increasing age. This has implications for the preoperative, intraoperative and postoperative management of elderly patients scheduled for thoracic surgery. Special focus has to be placed on preoperative evaluation, the ventilation regime and general intraoperative management. Effective postoperative pain treatment after geriatric thoracic surgery requires careful pain assessment and drug titration.

Summary Considering key points of physiology and pharmacology can help to provide best possible care for the increasing number of elderly patients in thoracic surgery. Management of geriatric patients in thoracic surgery offer opportunities for anaesthetic interventions including protective ventilation, use of different anesthetics, anaesthesia monitoring, fluid management and pain therapy.

Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke University, Magdeburg, Germany

Correspondence to Thomas Schilling, MD, PhD, DEAA, Assistant Professor in Cardiac and Thoracic Anesthesia, Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke University, Leipziger Str. 44, D-39120 Magdeburg, Germany. Tel: +49 391 6713500; fax: +49 391 6713501; e-mail:

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