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Is anesthesia safe for older adults?

It is estimated that in the United States, 15 million surgeries per year are performed on patients who are aged 65 and older. Surgery in this group, however, requires special considerations.

When appropriate, surgery may be scheduled in an ambulatory surgery center, often referred to as “day surgery.” This may be done for certain surgical procedures, including cataracts, colonoscopies, carpal tunnel repairs, knee arthroscopies and hernia repairs. However, these procedures may need to be done in a hospital if the patient has a complicated medical history or needs assistance after surgery. Functional status assessments of the patient’s ability to perform Activities of Daily Living (ADL) without assistance must be made.

The surgeon may request preoperative testing. There are no mandatory preoperative tests or studies based solely on age. Rather, the decision to order tests depends on the presence of disease and type of surgical procedure. Some common tests include an electrocardiogram (EKG), basic metabolic panel (lab test of electrolytes and urine function) and hematocrit (concentration of red blood cells).

Patients with complicated medical histories or scheduled for general anesthesia are often sent for medical clearance by their primary care physician who is more familiar with their medical history. In certain circumstances, a patient may need clearance by a specialist such as a cardiologist, pulmonologist or endocrinologist. These physicians can assist with optimizing a patient’s health and ordering specialized tests before surgery that can improve their overall course. Primary care physicians often refer patients to their surgeon and are aware that a surgery may be indicated. However, it is recommended that patients inform their primary care doctor and specialists if they are scheduled to have a procedure or surgery.

Patients should be given instructions on their medication schedule for the days prior to the surgery and on the morning of the procedure. This decision is based upon the primary care physician, surgeon and anesthesiologist’s expertise and policies. Appropriate management and adherence to instructions can avoid cancellation of surgery and decrease the risk for complications.

Anesthesiology advances and delivery choices have promoted patient safety with minimal side effects. The older adult's surgery type and general health influence the anesthesia plan and choices. It is important to communicate with surgeon, anesthesiologist and the primary care provider to assure that the older adult's health is maximized. This may involve preoperative cardiac and lab testing to assure that the person is medically stable for the planned surgery. Any previous adverse reactions to anesthesia, allergies and a list of current daily medications should be part of the older adult's preoperative evaluation.

All anesthetic techniques have some risks associated with them. More important than your age are such factors as your medical condition and your type of surgery. Various safety measures and precautions are taken in the delivery of your anesthesia care to help prevent unwanted events, just as you take certain safety precautions when driving a car or crossing the street. As a result, anesthesia today is safer than ever before for all age groups and for ambulatory outpatients as well as hospitalized patients. If you are an outpatient, it is essential that you arrange for a reliable adult to take you home because your coordination, decision-making ability and driving abilities may be somewhat impaired for up to 48 hours. 

It is important for you to realize that you will be dependent on others for a period of time, but your independence will return.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.