Respiratory complications after surgery account for approximately 40% of the perioperative deaths in patients over 65 years of age.<sup>16 Djokovic J.L., Hedley-Whyte J. Prediction of outcome of surgery and anesthesia in patients over 80 JAMA 1979 ;  242 : 2301-2306

Cliquez ici pour aller à la section Références, 47 Morgan R.F., Hirata R.M., Jacques D.A. , et al. Head and neck surgery in the aged Am J Surg 1982 ;  144 : 449-451  [cross-ref]

Cliquez ici pour aller à la section Références, 61 Seymour D.G., Vaz F.G. Aspects of surgery in the elderly: Preoperative medical assessment Br J Hosp Med 1987 ;  37 : 102-112

Cliquez ici pour aller à la section Références</sup> Although pulmonary dysfunction is more frequent in elderly patients after anesthesia and surgery, age itself is considered to be only a minor risk factor for perioperative pulmonary dysfunction until the ages of natural death are reached.<sup>29 Hankinson J.L., Odencrantz J.R., Fedan K.B. Spirometric reference values from a sample of the general U.S. population Am J Respir Crit Care Med 1999 ;  159 : 179-187

Cliquez ici pour aller à la section Références, 46 Mohr D.N. Estimation of surgical risk in the elderly: A correlative review J Am Geriatr Soc 1983 ;  31 : 99-102

Cliquez ici pour aller à la section Références</sup> Nonetheless, with advancing age a significant decrement in the functional capacity of the respiratory system occurs.<sup>72 Variakojis R.J., Roizen M.F. Preoperative evaluation of the elderly Geriatric Anesthesiology Baltimore: Williams & Wilkins (1997).  165-185

Cliquez ici pour aller à la section Références</sup> Longitudinal data show that even in older athletes, physiologic respiratory capacities progressively deteriorate with age despite continued vigorous endurance exercise (approximately 10% per decade).<sup>44 McClaran S.R., Babcock M.A., Pegelow D.F. Longitudinal effects of aging on lung function at rest and exercise in healthy active fit elderly adults J Appl Physiol 1995 ;  78 : 1957-1968

Cliquez ici pour aller à la section Références, 54 Pollock M.L., Mengelkoch L.J., Graves J.E. Twenty-year follow-up of aerobic power and body composition of older track athletes J Appl Physiol 1997 ;  82 : 1508-1516

Cliquez ici pour aller à la section Références</sup> Accordingly, the ability to deliver more oxygen to tissues than they require (“reserve capacity”) decreases by a factor of four from the age of 20 to the age of 70 years in apparently healthy individuals.<sup>26 Gerstenblith G., Lakatta E., Weisfeld M. Age change in myocardial function and exercise response Prog Cardiovasc Dis 1976 ;  19 : 1-21  [cross-ref]

Cliquez ici pour aller à la section Références, 64 Smith T.C. Respiratory effects of aging Seminars in Anesth 1986 ;  5 : 14-22

Cliquez ici pour aller à la section Références</sup>

Inadequacy of respiratory function becomes particularly relevant in the supine position during anesthesia, as well as postoperatively.<sup>13 Craig D.B., Wahba W.M., Don H.F. , et al. “Closing volume” and its relationship to gas exchange in seated and supine positions J Appl Physiol 1971 ;  31 : 717-721

Cliquez ici pour aller à la section Références, 14 Craig D.B. Postoperative recovery of pulmonary function Anesth Analg 1981 ;  60 : 46-52

Cliquez ici pour aller à la section Références, 24 Germain M.G., Wahba W.M., Gillies D.M. Ventilation following induction of general anaesthesia with thiopentone Can Anaesth Soc J 1982 ;  29 : 100-104  [cross-ref]

Cliquez ici pour aller à la section Références</sup> A variety of coexisting factors, prevalent in the elderly surgical patient, further predispose to pulmonary complications. These factors include smoking, obesity, and pre-existing pulmonary pathology. Chronic obstructive pulmonary disease (COPD—chronic bronchitis and emphysema), principally a geriatric disorder, is considered to be one of the major risk factors for post-coronary artery bypass graft (CABG) morbidity and mortality.<sup>29 Hankinson J.L., Odencrantz J.R., Fedan K.B. Spirometric reference values from a sample of the general U.S. population Am J Respir Crit Care Med 1999 ;  159 : 179-187

Cliquez ici pour aller à la section Références</sup> Prolonged operations (longer than 6 hours) and thoracic or upper abdominal surgery significantly increase the risk for perioperative respiratory complications. Nonetheless, the number of elderly patients with pulmonary disease undergoing surgery, including high-risk procedures, is rapidly growing.<sup>40 Loop F.D., Lytle B.W., Cosgrove D.M. , et al. Coronary artery bypass graft surgery in the elderly: Indications and outcome Cleve Clin J Med 1988 ;  55 : 23-34

Cliquez ici pour aller à la section Références, 76 Zaugg M., Lucchinetti E., Zalunardo P.M. , et al. Substantial changes in arterial blood gases during thoracoscopic surgery can be missed by conventional intermittent laboratory blood gas analyses Anesth Analg 1998 ;  87 : 647-653  [cross-ref]

Cliquez ici pour aller à la section Références</sup> A better understanding of the altered physiology in the aged respiratory system may help to improve patient care and outcome.

The purpose of this article is to sketch a panorama of the major age-related changes in the respiratory system. The following topics are addressed and their anesthetic implications discussed: