Characteristics of anesthetic management in elderly patients with frailty syndrome

The increase in the proportion of elderly people has led to a proportional increase in geriatric patients undergoing surgical treatment. Elderly patients often develop geriatric syndromes, one of which is the frailty syndrome. Aim. Based on the analysis of scientific literature, to emphasize the specifics of anesthetic care for surgeries in patients with frailty syndrome. Materials and methods. To achieve the goal, a search and analysis of full-text articles in the PubMed, Web of Science, Google Scholar, Scopus databases was conducted using the key terms “frailty syndrome” and “anesthesia”, including randomized controlled trials and meta-analyses and covering English- and Ukrainian-language publications over the past 10 years (from September 2014 to September 2024). A total of 390 publications were selected and analyzed. Results. Currently, more than 20 different tools for assessing frailty are known in the literature. The most suitable for preoperative assessment were the Clinical Frailty Scale, the FRAIL scale, and the most informative was the Comprehensive Geriatric Assessment. Strictly controlled general anesthesia with extended monitoring and continuous adjustment of almost all organ functions should be considered for most frail patients when choosing an anesthesia method. Aging affects the pharmacokinetics and pharmacodynamics of drugs. The dosage of most modern anesthetic agents should be reduced by 25–75 % in patients with senile frailty. In the postoperative period, rational analgesia and cardiorespiratory monitoring should be provided. Conclusions. The anesthetic management plan should include a detailed preoperative assessment, selection of the optimal method of intraoperative analgesia, structured intraoperative procedures, and a course of postoperative treatment with adequate pain relief. Optimal perioperative management of patients with frailty syndrome requires close interdisciplinary, interprofessional, and interdisciplinary collaboration to minimize adverse postoperative outcomes.