Michelle Perez Roman, MD1, Anna Roth MD3 Vikram Bhasin MD1,2Elilary Montilla Medrano MD1,2  
1Department of Anesthesiology, Montefiore Medical Center and 2Albert Einstein College of Medicine, NYC Health Hospitals/South Brooklyn Health3

 

Introduction

The high incidence of hip trauma in the elderly population likely due to a high risk of mechanical falls and conditions like arthritis, combined with the high likelihood of having other severe comorbidities makes the anesthetic management for these cases very challenging. When making an anesthetic plan for corrective hip surgery, it is important to consider the possible complications of each anesthetic approach and the implications they might have on the specific patient comorbidities. Neuraxial is usually preferred for management in the elderly population to avoid the increased risk of respiratory complications, postoperative delirium and mortality that is associated with general anesthesia. In the case of a patient the has significant cardiovascular comorbidities, the sympathectomy associated with neuraxial anesthesia could lead to significant hemodynamic instability.

Case Report

Case of a 98-year-old female nursing home resident with medical history of severe aortic stenosis with an aortic valve area of 0.7cm^2, moderate pulmonary hypertension with an estimated pulmonary artery systolic pressure of 54mmHg, heart failure with preserved ejection fraction, left bundle branch block with a permanent pacemaker in place, uncontrolled hypertension and Alzheimer's disease. The patient presented with a displaced right femoral neck fracture after a fall. Prior to the fall the patient was minimally ambulating with a walker. The patient was scheduled for a right hemiarthroplasty with the goal of pain control and recovering some mobility.