Anesthesia for Major Vascular Procedures in the Elderly

Vascular surgery has progressed to a point where the elderly patient is commonly a candidate for a variety of surgical procedures. Anesthetic management of these high-risk patients must be directed towards support of the various systems involved in this diffuse process. Of primary concern is the cardiovascular system which accounts for a significant early postoperative mortality. Evaluation of the degree of coronary artery disease in conjunction with the cardiologist allows appropriate preoperative decision to be made including initial revascularization of the coronaries as well as the operative monitoring needs. The pulmonary, renal and central nervous systems are also at risk and must be supported. The use of invasive cardiovascular monitoring and a variety of vasoactive drugs have permitted the care of these patients to be carried out in a very physiologic manner. Surgeons and anesthetists working in close communication and understanding each other's problems have given elderly high-risk patients many more useful years.