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Volume 10 Supplement 1

de Senectute: Age and Health Forum

Anesthetic agents and elderly

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Background

The elderly (≥65 yr) are more sensitive to anesthetic agents and generally require smaller doses for the same clinical effect, and drug action is usually prolonged [1].

Minimum alveolar anesthetic concentration (MAC), decreases approximately 6% for every decade. There is altered activity of neuronal ion channels associated with acetylcholine, nicotinic and GABA receptors [2].

The elderly require less doses for pain relief. Morphine clearance is decreased in the elderly. Sufentanil, alfentanil, and fentanyl are twice as potent in the elderly, due to an increase in brain sensitivity to opioids with age. There are changes in pharmacokinetics and pharmacodynamics of remifentanil, which is more potent in geriatric patients. Clearance and the volume of the central compartment decrease with age and the infusion rates should be titrated [3]. Cisatracurium undergoes Hofmann degradation and is unaffected by age [4]. In the peripheral nerve blocks the duration of analgesia may be prolonged with age depending on the baricity of the bupivacaine solution. When using 0.75% ropivacaine for nerve blocks, age is a major factor in determining the duration of motor and sensory block. When general anesthesia carries great risk for the patient, administrating regional anesthesia if possible could provide an excellent solution [5].

Conclusions

Age-associated change of the physiological systems results in impaired function and reserve, which affects most of the organs (there is of course variability of such decline between patients). The importance of this, when it comes to anaesthesia is that such a patient is less able to respond to perioperative stress and more likely to suffer from an adverse postoperative outcome.

References

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    Ergina PL, Gold SL, Meakins JL: Perioperative care of the elderly patient. World J Surg. 1993, 17: 192-198. 10.1007/BF01658926.

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    Amar D, Zhang H, Leung DH, Roistacher N, Kadish AH: Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology. 2002, 96: 352-356. 10.1097/00000542-200202000-00021.

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    Grandison MK, Boudinot FD: Age-related changes in protein binding of drugs: implications for therapy. Clin Pharmacokinet. 2000, 38: 271-290. 10.2165/00003088-200038030-00005.

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    Kirkbride DA, Parker JL, Williams GD, Buggy DJ: Induction of anesthesia in the elderly ambulatory patient: a double-blinded comparison of propofol and sevoflurane. Anesth Analg. 2001, 93: 1185-1187. 10.1097/00000539-200111000-00026.

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    Miller R: Miller’s Anesthesia. 2004, Churchill Livingstone, 6

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Author information

Correspondence to F Calandese.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Calandese, F., Caroleo, S., Amantea, B. et al. Anesthetic agents and elderly. BMC Geriatr 10, L53 (2010) doi:10.1186/1471-2318-10-S1-L53

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Keywords

  • Morphine
  • Fentanyl
  • Bupivacaine
  • Remifentanil
  • Nerve Block