**12.1 Fluid management**

Generally, fluid management should provide into account the combined effects of aging, anesthetics, analgesics, and anxiolytics on physiology. Appropriate use of intravenous fluids in geriatric patients is essential to avoid unpleasant effects of fluid administration. Insufficient hydration may often quickly deteriorate in organ functions. In high-risk geriatric patients, numerous studies have proven that goal-directed hemodynamic therapy significantly reduced postoperative morbidity and mortality [23, 24]. However, perioperative fluid monitoring is essential. The surgical patients will have been fluid depleted for at least 4-6 hours before. An anesthesiologist must be concerned of the volume status. In addition, fluid balance should be maintained during the procedure.

## **12.2 Pain management**

A proper analgesic plan should be conducted in every geriatric patient before an operation. Many geriatric patients hurt from acute or chronic pain and increasingly apply management for their condition. Depression is common in the geriatric patients and is probable to be faced in the geriatric patient with chronic pain. Therefore, the overall proportion of chronic pain management applications increased in this population. Epidural anesthesia should be intensely considered in geriatric patients, as they offer improved function after abdominal surgery. The overwhelming majority of pain lawsuit in the claims database contained invasive procedures such as blocks and injections. An anesthesiologist should concern any unpredicted motor and/or sensory findings, and should cautiously monitor the geriatric patients for a prolonged time after the neuraxial blockade.

## **13. Postoperative care**

### **13.1 Oxygen therapy**

The geriatric patients are less able to increase and preserve ventilation at high levels. In addition, the responsiveness of central nervous system to hypoxia and hypercarbia is reduced. The reduction of protective reflexes, coughing and

swallowing with age can cause recurrent aspirations and pulmonary damage. The greatest incidence of myocardial ischemia is on day 2 or 3 postoperatively. Owing to the abnormalities in gas exchange characteristic of the geriatric patients, it is suggested that they should be transported to the postanesthesia care unit with 2-4 L/min of oxygen via nasal cannula, even after minor ambulatory surgery. Importantly, oxygen therapy and closed monitoring in a high dependancy unit might be required for geriatric patients.
