Elderly person of 80 years of age and older presents a specific challenge to anesthetists, who needs toacquire and maintain skill and expertise in the management of such patients. Departments should havea lead clinician with an interest in the care of the elderly. Development in anesthesia and operative techniques hasconsiderably reduced morbidity and mortality in the elderly patients.Several anesthetic techniques have been used for elderly patientsincluding general anesthesia, regional anesthesia, intravenoussedation and monitored anesthesia care. However, anesthesiarelatedmortality in these patients is still high. All elderly patientsundergoing surgical procedures require a preprocedural evaluationto assess the risks of anesthesia and procedure and to manageproblems related to the preexisting medical conditions, monitoringpatients during intraprocedural and postprocedural periods aswell as postprocedural management. This article considers theage-related physiological changes, preprocedure assessmentand preparation, anesthetic techniques, intraoperative care andpostoperative care. Age does not obtund the perception of pain. Acute and chronic pain management teams should be available totreat the elderly. Prophylaxis for Thrombo embolic disease should initiated to prevent further complications.