• Elderly
    • Renal
      • 50% decrease in the abiliy to excrete water +/or electrolytes due to loss of cortical glomeruli
      • The ability of the kidneys to deal with fluid is diminished
    • Neurological
      • Generalised loss of cells
      • Loss of baroreceptor reflexes
      • Blindness due to cataract and glaucoma
      • Deafness
      • Dementia 20% in over 80s
      • CVD
    • CVS
      • Atrial pacemaker cells decline so AF is common
      • Reduced maximal heart rate
      • CO altered by increasing SV rather than HR
      • PVR increases causing LVH
      • Hypotension on induction commoner
      • Reduced beta receptor sensitivity
      • Limit fluid to 8ml/kg then use vasopressor if SBP < 90mmHg
    • Locomotor
      • OA common
      • Falls
      • Balance problems
      • Limited fat for thermogenesis
      • Pressure areas/venous access
      • Difficulty with positioning and regional techniques
    • Temperature
      • Limited muscle bulk to return temp to normal
    • Regional techniques have a better 1/12 mortality but not at 3 months
    • GI
      • Reduced gut motility
      • Constipation
    • Pharmalogical implications
      • Induction doses reduced due to decreased protein binding
      • Prolongation of arm brain circulation time
      • Reduced hepatic clearance of induction agents
      • Opiates have increased elimination half life due to increased lipid content in elderly
      • MAC reduced and insoluble agents are taken up slowly due to V/Q mismatch and shunt. Their CC compounds this
      • NMBDs onset and duration of action both prolonged due to reduced c.o. and metabolism
    • Respiratory
      • Reduction of elastic support leading to collapse
      • CC encroaches on FRC by age 65
      • Airway collapse commoner while asleep
      • Silent aspiration common
      • More dependent on diaphragm due to chest wall rigidity
      • Lower pO₂ leads to peri-operative hypoxaemia
      • There is reduced ventilatory response to hypercarbia and hypoxaemia
      • Edentulous may be hard to maintain airway
    • Over 75s have a high rate of complications
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/6/1/37.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/1/6/181.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/4/6/193.full.pdf