Pharmacological Considerations for the Use of General Anesthetics in the Elderly

Aging is a physiological condition involving progressive degenerative modifications and loss of functionality in all organ systems. In general, aged patients are frail and sensitive to anesthesia and surgery. Clinical practice indicates that being more sensitive to anesthetic drugs and more susceptible to the side effects, elderly requires usually lower doses to reach the clinical anesthesia. This is mainly associated with the significant changes in pharmacokinetics (and pharmacodynamics) occurring with advancing age. However, how the dose–response relationship is affected by age should be better defined. This chapter focuses on the main changes that physiologically occur with age, how these changes affect organs and systems, and their impact on anesthetic care. The agents used in general anesthesia are discussed in detail with particular emphasis on aspects concerning the dose, safety, and efficacy of their use in the elderly. Moreover, we highlight some recent preclinical evidence on the use of general anesthetics in aged animals.