The principles underlying perioperative anaesthetic management of elderly surgical patients are: (i) Preoperative assessment for identifying high risk patients. (ii) Preoperative preparation. (iii) Routine precautions during major surgery. (iv) Haemodynamic stability. (v) Quick recovery. (vi) Postoperative care. Preoperative assessment alerts the anaesthesia providers to the physiological alterations during the period of surgical stress and is likely to effect the perioperative management of adverse situations and the necessity for preoperative optimization of associated medical diseases with the aim to highlight an index of risk and at the same time provide baseline data to be compared postoperatively. Preoperative assessment, thus, is composed of four inter-selected functions: risk stratification, history and physical examination including functional assessment, preoperative testing and preoperative optimization.