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Pharmacological considerations in the elderly

Akhtar, Shamsuddin

Current Opinion in Anaesthesiology: February 2018 - Volume 31 - Issue 1 - p 11–18
doi: 10.1097/ACO.0000000000000544
THORACIC ANESTHESIA: Edited by Paul M. Heerdt

Purpose of review This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly.

Recent findings Potency of anesthetic drugs is increased in the elderly. In addition to changes at the receptor level, neurophysiological changes in functional connectivity with aging contributes to increased sensitivity of anesthetic drugs. However, the extent of reduction is underappreciated by the practitioners and dose adjustment is not uniformly applied in practice. Large database studies demonstrate association of short-term intraoperative hypotension and CNS depression, to poor perioperative outcomes. These perturbations are probably of greater consequence in frail, elderly patients with reduced reserves.

Summary Anesthetic dosing should be more closely age-adjusted to prevent anesthetic-induced hypotension and increased depth of anesthesia in the elderly. Pharmacologic studies are required in the elderly population (>80 years).

Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

Correspondence to Shamsuddin Akhtar, Associate Professor, Anesthesiology and Pharmacology, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP # 3, PO Box 208051, New Haven, CT 06520-8051, USA. Tel: +1 203 785 2802; fax: +1 203 785 6664; e-mail:

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