Preanesthetic evaluation is one of the most important components of patient care before administration of anesthesia. A preanesthetic evaluation helps develop rapport between the patient and anesthesiologist, as it is usually the first time the patient comes in contact with the anesthesiologist. Preanesthetic checkup is the process of clinical assessment that precedes the delivery of anesthesia care for surgery and for nonsurgical procedures. The goals of preanesthetic evaluation in geriatric neurosurgical patients remain the same as when caring for other neurosurgical patients. Evaluating the patients for hypertension is vital, as the prevalence of hypertension increases with age. These patients have their cerebrovascular autoregulation curve shifted to the right, and this must be considered while planning anesthesia for these patients because such patients will tolerate any episode of hypotension very poorly. Serum creatinine has been shown as a poor predictor of renal function in older individuals because decreased body mass keeps serum creatinine normal even with decreasing renal blood flow.