The importance of the changes and variability in pharmacology with ageing and the risks these pose in the elderly are emphasized. Detailed descriptions are given of the pharmacokinetic aspects of distribution, initial volume of distribution, and plasma binding; elimination affected by hepatic and renal clearance changes; and effect site variability. The pharmacodynamics changes are then reviewed. Specific anaesthetic agents are then described, covering the induction agents thiopentone, propofol, etomidate, ketamine, and midazolam. The volatile anaesthetics sevoflurane and desflurane, and nitrous oxide are discussed. The opioid analgesics fentanyl, alfentanil, sufentanil, and remifentanil are described followed by the opiate morphine. The much slower onset and offset of muscle relaxants in the elderly is explained, and the differences between steroid and benzylisoquinolinium compounds are described. Finally, the reversal agents, including sugammadex, are reviewed.
Muscle Relaxants—Reversal Agents
