Dr. Feryal Akşan: Neurosurgical Anaesthesia in the Elderly

Dr. Feryal Akşan — Anaesthesiology and Reanimation Specialist

Anaesthesia Challenges in the Elderly Patient

Neurosurgical anaesthesia in patients over 65 years of age requires special attention. Cardiovascular diseases, decreased respiratory function, decline in kidney and liver capacity, drug interactions, and reduced physiological reserve complicate anaesthesia management.

Preoperative Evaluation

Comprehensive cardiac evaluation (ECHO, stress test if necessary), respiratory function tests, kidney function panel, nutritional status assessment (albumin, prealbumin), cognitive evaluation (delirium risk score), polypharmacy management (multiple drug use analysis). Frailty scoring is increasingly being used to determine surgical risk.^1,2

Neurosurgical anaesthesia in patients over 65 years of age requires special attention.

Intraoperative Management

Haemodynamic Stability: Avoiding blood pressure fluctuations — impaired cerebral autoregulation in elderly patients can increase the risk of cerebral malperfusion.³ Target: keeping within 20% of preoperative values.⁴

Brain Protection: Avoiding hypothermia, normocapnia, optimal oxygenation.

Fluid Management: Avoiding fluid overload. Goal-directed fluid therapy (GDFT) may reduce postoperative complications in some types of surgery, but its superiority over standard treatment has not been definitively proven in every patient group.^5,6

Postoperative Delirium

Prevention: pain management, early mobilisation, maintaining the sleep-wake cycle, presence of familiar people, sensory support (glasses, hearing aids). Early diagnosis and intervention are of critical importance.

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