Anesthesia for patients with severe systemic debilitation.

Any patient presenting for anesthesia and surgery who has a severe debilitating problem is at great risk for a prolonged recovery, renal failure, or hypotension. A stable hemodynamic state should be maintained. Fluid homeostasis should be ensured. Anesthetic induction techniques using narcotics and benzodiazepines are my preferred approach, with maintenance of anesthesia incorporating isoflurane, narcotics, or both or the use of regional anesthesia.