[Anesthetic management of elderly patients in urologic oncology]

Age should not be a limiting factor for optimal surgical care of cancer. Preoperative assessment and therapeutic line decision must be a multidisciplinary team work. A specific geriatric oncology consultation would help assessing the level of autonomy or dependence, the patient cognitive functions and his nutritional status. The preoperative interview and clinical examination aim to assess the overall general health of the patient and to detect cardiovascular, pulmonary and neurological disorders which are the main postoperative factors of morbidity and mortality, other than related to tumor itself. Many scores of surgical risk assessment have been proposed. The Charlson index and the CIRS-G are the most widely used. Because of pharmacokinetic and pharmacodynamic changes related to age, new anesthesia techniques, such as target intravenous anesthesia (TIVA), which allow fine adjustment of anesthesia level according to the patient individual parameters (age, weight, height, sex) will be preferred. The most frequent postoperative complications are those related to hypothermia, pain and postoperative cognitive dysfunction. The main objective of the preoperative care of the elderly person is a rapid return to autonomy in a familiar environment.