Anaes Cases · Anaesthesia for the co-morbid & elderly
Anaesthesia for the hip fracture in the frail elderly patient
The long case — the hip fracture in the frail elderly. The frailty and the dementia assessment, the DOAC management (the apixaban hold), the delirium prevention, the spinal versus the general anaesthesia, the goal-directed fluid, the early mobilisation, and the shared decision-making.
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Prompt
An 86-year-old woman, frail, with the atrial fibrillation on the apixaban and the mild dementia, for the urgent hip fracture repair. Discuss the perioperative management.
Presentation
An 86-year-old woman, Clinical Frailty Scale of 6 (moderately frail, needs help with housework and shopping), with atrial fibrillation on apixaban, hypertension, and mild dementia (Montreal Cognitive Assessment of 22), falls at home and sustains a displaced femoral-neck fracture. She is scheduled for hemiarthroplasty within 36 hours. Discuss the perioperative management.
References3ShowHide
- [1]Coetzee E, et al. Pharmacokinetic and pharmacodynamic changes in the elderly. Anesthesiology Clinics, 2023.PMID 37516494
- [5]Budiarto RM, et al. Contemporary approaches to perioperative anticoagulant management in surgical patients: a literature review. Curr Med Res Opin, 2026.PMID 41763902
- [2]Wu JN, et al. The Impact of General Anesthetics on Postoperative Delirium: A Narrative Review Based on Clinical Randomized Controlled Trials from the Last Five Years. Geriatrics (Basel), 2026.PMID 42345745