Providing perioperative care for patients with hip fractures

Abstract

Providing perioperative care for patients with hip fractures can present major challenges for the anaesthesiologist. These patients often have multiple comorbidities, the deterioration of any one of which may have precipitated the fall. A careful balance has to be achieved between minimising the time before operation and spending time to optimise their medical status. This review will present insights into preoperative patient assessment and optimization in this group of patients from the anaesthesiologists’ perspective. In particular, it will highlight important medical issues of concern that may alter anaesthetic risks and management. With a greater understanding of what these issues are, potentially a more prompt and integrated approach to managing these patients may be made. Hopefully, this would result in minimising last minute cancellations due to medical reasons for these patients.

Treatment of Protrusio Fractures of the Acetabulum in Patients 70 Years and Older

“…This is not dissimilar to our standard protocol for geriatric hip fractures. [6][7][8][9] The goal of this assessment was to minimize intraoperative hypotensive events, judiciously manage intraoperative fluid replacement, and optimize hemoglobin/hematocrit facilitated by central venous catheter and arterial line monitoring performed by the anesthesia service. All cases were performed in the supine position on a pelvic fracture table capable of applying a mechanical lateral distraction to the hip.…”

Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture

“…Emerging evidence suggests that early surgery decreases mortality and minimizes complications secondary to immobilization [5, 6]. However, the perioperative evaluation for hip fracture patients can represent a major challenge, since these patients normally have multiple comorbidities [6, 7]. Thus, extensive preoperative evaluation may lead to worse outcomes.…”

Special Anesthetic Consideration for the Patient with a Fragility Fracture

“…Parameters such as pre-operative FEV 1 less than 50% of predicted or forced vital capacity of less than 1.7 liters are associated with a higher likely hood of CO2 retention. 6 …”

“…The presence of delirium preoperatively warrants investigation to rule out serious conditions like hypoxia, hypoglycemia, electrolyte imbalances or sepsis. 6 Neuroimaging may be necessary if history or signs point to a cerebrovascular accident (CVA). A recent CVA is associated with impaired autoregulation of the cerebral vasculature and hemodynamic stress associated with general anesthesia could make the infarction worse.…”

“…A recent CVA is associated with impaired autoregulation of the cerebral vasculature and hemodynamic stress associated with general anesthesia could make the infarction worse. 6 …”