ANESTHETIC MANAGEMENT IN ELDERLY PATIENTS: CLINICAL FEATURES, RISKS, AND OPTIMIZATION STRATEGIES

Abstract

          Background: Population aging has led to a growing number of elderly patients requiring anesthesia for surgical procedures. Age-related physiological changes, comorbidities, and altered pharmacological responses increase perioperative risks and complicate anesthetic management in this population.

          Objective: This review aims to analyze current evidence on anesthetic management in elderly patients, focusing on clinical features, perioperative risks, and strategies for optimizing anesthetic care to improve safety and outcomes.

          Methods: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Publications from 2005 to 2025 addressing anesthetic management, perioperative risks, and optimization strategies in patients aged 65 years and older were analyzed and synthesized qualitatively.

          Results: Elderly patients exhibit significant cardiovascular, respiratory, renal, hepatic, and neurological changes that influence anesthetic risk. Altered pharmacokinetics and pharmacodynamics necessitate dose adjustment and individualized drug selection. Common complications include hemodynamic instability, respiratory depression, postoperative delirium, and cognitive dysfunction. Evidence supports the use of comprehensive preoperative assessment, multimodal and opioid-sparing anesthesia, careful intraoperative monitoring, and structured postoperative care to reduce complications and enhance recovery.

          Conclusion: An individualized, physiology-based approach to anesthetic management is essential for improving perioperative safety and outcomes in elderly patients. Optimized anesthetic strategies tailored to aging-related vulnerabilities can reduce complications and support functional recovery.