Neurosurgical anesthesia for the elderly: Is age really just a number?

Advances in medicine have increased the survival and health of our population in recent years. The result is an increasing age trend that has led to growth in the surgical sector overall and in the neuroscience service line. The geriatric patient with aging organ systems combined with neurologic disease presents unique challenges to the neuroanesthesiologist. The aim of this chapter is to review the perioperative challenges of the elderly patient as they pertain to neurosurgical anesthesia. We will explore the pertinent preoperative findings and identify risk factors most relevant to the neurosurgical patient. The individualized anesthetic plan will be discussed based on procedure, need for neurophysiological monitoring, patient’s age-related comorbid conditions, baseline neurologic condition, and necessary preoperative testing. The anesthetic plan segues to intraoperative management including positioning for key neurosurgical procedures commonly performed in the geriatric population. We will also discuss troubleshooting commonly anticipated complications to the described procedures. Our discussion will conclude by highlighting themes in postoperative ICU including pain management in this vulnerable population.