ABSTRACT
With age as an independent risk factor for perioperative morbidity and mortality, it is important for providers to have a working knowledge of age-related changes in pharmacokinetics and pharmacodynamics of the geriatric patient requiring neuroanesthesia. Neuroanesthetic challenges facing the clinician when caring for geriatric patients include polypharmacy, drug interactions, drug-disease interactions, alterations in typical response to perioperative medications, and postoperative cognitive dysfunction. Absorption, distribution, metabolism, and excretion of medications are affected with the aging process and disease states associated with increasing age. Age-related loss in brain mass impairs normal neuronal function in both excitatory and inhibitory neurotransmitter receptors. Geriatric patients are frequently prescribed neuroleptic and antipsychotic medications. Multifactorial changes within the cardiovascular system lead to impaired medication response in the elderly compared to younger individuals. Reduced compliance and elasticity of arteries leads to increased systolic blood pressure, decreased cardiac output, and decreased left ventricular ejection with left ventricular hypertrophy.
