Preoperative Considerations

Evaluation: The anesthesiologist must determine whether the patient is in optimal condition for surgery. Medical disorders superimposed on age-related physiologic changes will complicate anesthesiologic management. Consequently, a detailed history and a thorough physical examination are necessary. The drug history can provide information about disorders that may affect the use of anesthetics (see Table 27-3). The patient's primary care physician should be contacted to obtain records of past medical history, functional status, drug use, and allergies. If possible, the results of tests given just before anesthetics are used should be compared with the results of similar tests given earlier by the primary care physician.

Preoperative sedation: Many anesthesiologists do not give sedatives to elderly patients preoperatively because these drugs reduce the already compromised ventilatory response to hypoxia and hypercapnia. Because currently used anesthetics produce fewer respiratory tract secretions, muscarinic anticholinergics (eg, atropine, scopolamine, glycopyrrolate) are generally not needed to decrease secretions; also, they are particularly problematic in persons with dementia, glaucoma, and benign prostatic hyperplasia. If an anticholinergic is necessary, glycopyrrolate, which is poorly lipid soluble and does not cross the blood-brain barrier, is the drug of choice. Atropine and scopolamine can cause central nervous system adverse effects. Atropine may produce excitement and delirium; scopolamine can cause agitation, restlessness, and hallucinations.