Title: Anaesthetic Management of COVID-19 Suspected Patient Posted For Proximal Femoral Nailing – A Case Report

Authors: Dr J.Sivagurunathan, Dr B.Balamurugan

 DOI: https://dx.doi.org/10.18535/jmscr/v9i10.12

Abstract

Overall 1.6 million patients suffer from hip fracture every year, and it has increased by 25% every decade as the population continues to grow. After hip fracture, in-hospital mortality ranges from 2.3 to 13.9%, yet the danger continues beyond the immediate surgical period with 6-month mortality rates ranging from 12 to 23%1. Hip fractures are the commonest reason for older people to require emergency surgery, hospital admission and account for more orthopaedic trauma beds occupied than all other fractures combined2. Combined spinal epidural anaesthesia stands an effective mode of analgesia for these patients with hip fractures after the COVID -19 pandemic. Studies have shown that there is a possible connection between COVID-19 infection and fragility hip fracture in elderly patients3. It could be induced by fatigue and weakness due to COVID-19 disease. Management of geriatric patients can be a challenge to anaesthesiologist due to limited organ reserve, the compromised organ function, and the unique disease predispositions4.The safety of the medical personnel, including the overall safety of the medical team participating in the rescue, must also be prioritized. All personnel involved in the emergency traumatic orthopaedic surgery should select different levels of personal protective equipment (PPE) according to their risk assessment. 

Keywords: hip fractures, elderly patients, COVID-19.

References

  1. Boddaert J, Raux M, Khiami F, Riou B. Perioperative Management of Elderly Patients with Hip Fracture. Anesthesiology. 2014;121(6):1336-1341.
  2. C, White. S. “Anaesthesia for Hip Fracture Repair.”BJA Education,  2020;20(5): 142–149.
  3. Shariyate MJ, Kachooei AR.Association of new coronavirus disease with fragility hip and lowerlimb fractures in elderly patients.Arch Bone Jt Surg. 2020 4;8(suppl 1 ): 297-301.
  4. Gupta A, Kulshreshtha A, Kalra P, Sharma M, Nanda S. Anesthetic management of a 137-year-old patient fracture of neck femur. Journal of Anaesthesiology Clinical Pharmacology. 2012;28(1):143.
  5. Maxwell L, White S. Anaesthetic management of patients with hip fractures: an update. Continuing Education in Anaesthesia Critical Care & Pain. 2013;13(5):179-183.
  6. Guay J, Parker M, Gajendragadkar P, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database of Systematic Reviews. 2016.

Corresponding Author

Dr J.Sivagurunathan

Post Graduate, Chettinad Hospital and Research Institute, Kelambakkam-Chennai, India