For all organ systems, aging is associated with a loss of physiologic reserve that increases the vulnerability to disease and decreases the ability to compensate for stress. For the general population, the risk of dying doubles every 8.5 years.<sup>21 Kohn R.R., Monnier V.M. Normal aging and its parameters Clinical Pharmacology in the Elderly New York: Marcel Dekker (1987).  3-30

Cliccare qui per andare alla sezione Riferimenti</sup> It is interesting to note that this doubling time also applies to the risk of death from individual diseases such as appendicitis, pneumonia, cardiovascular disease, and many forms of cancer. When one examines perioperative mortality, the risk of dying also doubles with roughly every additional decade of age.<sup>36 Roy R. Anesthetic implications of the rectangular survival curve Geriatric Anesthesiology Baltimore: Williams & Wilkins (1997).  13

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Hemodynamic stability is one of the major goals and challenges in the administration of an anesthetic. Not only does the aging process make that stability more difficult to achieve; aging and age-related disease may make hemodynamic instability more likely to lead to adverse outcomes. Cardiovascular and autonomic aging makes blood pressure inherently more unstable during anesthesia, primarily because of exaggerated responses to changes in ventricular filling, exaggerated responses to changes in sympathetic nervous system activity, and impaired baroreflex control of blood pressure owing to a decreased response to beta-receptor stimulation. Concomitant vascular disease may lead to organ hypoperfusion at blood pressures that would be easily tolerated by a young, healthy adult.

The goals of this article are to review the physiology of cardiovascular aging, to describe what is known about the effect of anesthesia on the aged cardiovascular system, and to discuss strategies for hemodynamic management in the elderly patient.