ABSTRACT
Anesthesia is expected to be challenging in elderly patients suffering from neurotrauma. A careful understanding of the pathophysiology of neurologic injury and the physiologic and pharmacologic changes of aging is essential to deliver safe anesthesia for elderly neurotrauma patients. The pathophysiologic effects of neurotrauma in the elderly, as in the general population, include primary and secondary effects. Primary effects are the result of the traumatic impact and lead to a cascade of injurious secondary effects in the form of ischemia, and excitoxicity and initiation of inflammatory processes. Geriatric patients are much more predisposed to such consequences of neurotrauma because of the aging-associated anatomic degenerative changes and the gradual decline in organ function. Furthermore, there is a scarcity of information about central nervous system (CNS) trauma in the elderly and perioperative anesthetic management. This has prompted the implementation of guidelines derived from previous investigations primarily done in the young adult population. Thus, anesthetic management follows the same basic principles of geriatric anesthesia coupled with the concepts of anesthesia for patients with CNS trauma. Also, anesthetic management should take into account what is currently known about the interaction between the pathophysiology of aging and the effects of neurotrauma.
