The aging respiratory system: Anesthetic strategies to minimize perioperative pulmonary complications

Because of increased life expectancy, the number of elderly individuals over the age of 65 is increasing all over the world, especially in developed countries. Although respiratory function is relatively well preserved in resting elderly patients, reduced respiratory reserve may lead to problems in the setting of acute illness or surgery. To anticipate and prevent potential problems that may result from reduced respiratory reserve, it is important to understand the effects of aging on respiratory function. Such changes may have particular significance during the perioperative period when numerous anesthetic and surgical factors, such as body positioning, residual effects of anesthetics on control of respiration, structural and functional disruption of respiratory muscles, and perioperative changes in lung fluid balance, may impose additional burdens on elderly patients with diminished pulmonary reserve. Indeed, postoperative respiratory complications account for approximately 40% of the perioperative deaths in patients over 65 years of age.¹ In this chapter, we review the effects of aging on pulmonary function and the effects of anesthesia and surgery on this function.