GERIATRIC ANESTHESIA

CARDIOVASCULAR CHANGES

Vascular and Myocardial Changes: The vasculature and myocardium experience progressive
stiffening and loss of compliance due to a gradual reduction of elastin, increased collagen, and
damage from glycosylation and free radicals. This leads to increased systolic arterial blood
pressure, pulse wave velocity, and impedance to left ventricular outflow, contributing to
myocardial hypertrophy and reduced compliance.

Diastolic Dysfunction: Elderly patients often exhibit impaired relaxation of the left ventricle
during diastole, resulting in a substantial decrease in early diastolic filling. This can lead to
dependency on adequate atrial pressures and active atrial contraction for diastolic filling,
especially as much as 50% reduction compared to younger patients.

Cardiovascular Autonomic Function: Aging results in decreased vagal or parasympathetic tone

along with increased sympathetic nerve activity and higher plasma levels of noradrenaline. This
combination leads to decreased responsiveness of β-adrenergic receptors, labile arterial blood
pressure, and a greater susceptibility to orthostatic hypotension, particularly during anesthesia
and in volume-depleted patients.

Conduction Abnormalities: Myocardial fibrosis and fatty infiltration contribute to conduction

issues like sick sinus syndrome, atrial fibrillation, and premature atrial contractions.
Consequently, elderly patients may experience exaggerated bradycardia following the
administration of opioids.

Cardiovascular Disease: The aging process often coincides with the development of
cardiovascular diseases. Hypertension becomes more prevalent, which increases the risk of
congestive heart failure. Congestive heart failure is a major risk factor for adverse outcomes
after anesthesia and surgery.