Pharmacology in the elderly and newer anaesthesia drugs

In developed countries, a growing proportion of patients presenting for anesthesia and surgery are elderly. Despite this, and the fact that aging is known to be associated with alterations in drug pharmacokinetics and dynamics, there is little detailed information about the impact of aging on the pharmacology of commonly used anesthetic agents.In this review, we discuss existing current knowledge on the physiological changes that occur with age and the way these changes affect the pharmacokinetics and dynamics of anesthetic agents. Also, an overview of up-to-date PK-PD modeling concepts and their usefulness and limitations in modern anesthesiologic practice with respect to the elderly population is given. Finally, newer agents such as sugammadex, remifentanyl, ropivacaine and desflurane are discussed in detail with emphasis on current evidence concerning dosing, safety and efficacy of their use in the elderly.

► Standard anesthetic doses cause more profound clinical effects in the elderly.
► This is the result of differences in both pharmacokinetics and dynamics.
► Lower doses are required for propofol, remifentanil, ropivacaine and desflurane.
► Standard doses of sugammadex are required in the elderly.
► Future PK/PD studies should specifically focus on the elderly population.