Ugeskrift for laeger
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This paper focuses on the current evidence regarding age as an independent predictor of impaired post-operative outcome and on the possibilities of perioperative interventions in elective and emergent surgery. Co-morbidity and functional parameters, i.e. frailty, are better predictors than age and can be combined with intraoperative data to help identifying patients who might benefit from increased level of care and observation. Most elderly patients go through surgery without impaired outcome, however, further studies are needed to identify who might benefit from increased level of care.
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The management of post-operative pain in the elderly represents a challenge due to coexisting diseases, concurrent medications, and age-related pharmacodynamic and pharmacokinetic changes. Analgesic therapy in this group of patients should balance the potential efficacy with the risk of interactions and side effects. In general, doses should be smaller and the dosing intervals longer ("start low and go slow") and the use of regional blocks and non-pharmacological treatment should be encouraged. Continuous assessment of pain, pain relief and side effects is particularly important in elderly patients.