Khan Ejaz, Nawaz Shoaib, Inam Kiran, Alali Malek, Waqas Muhammad
Anesthesiology, New York Medical College, Metropolitan Hospital Center, New York, USA.
Anesthesiology, Peshawar Institute of Cardiology, Peshawar, PAK.
Cureus. 2024 Sep 6;16(9):e68836. doi: 10.7759/cureus.68836. eCollection 2024 Sep.
This case report details the perioperative challenges and anesthesia strategies in managing severe pulmonary hypertension (PH) during emergency orthopedic surgery. An 86-year-old male with multiple comorbidities, including severe PH, presented with a hip fracture. Multidisciplinary collaboration was crucial for preoperative optimization, including transfusions, antithrombotic discontinuation, and thromboprophylaxis initiation. Anesthesia management included the use of spinal anesthesia combined with a precautionary epidural catheter insertion, low-dose hyperbaric bupivacaine, and continuous monitoring to prevent hemodynamic instability. Postoperatively, the patient was closely monitored in the surgical intensive care unit. This case highlights the necessity of meticulous planning and proactive monitoring in optimizing outcomes for severe PH in emergency orthopedic surgery.
本病例报告详细介绍了急诊骨科手术中处理重度肺动脉高压（PH）时的围手术期挑战及麻醉策略。一名86岁男性，患有多种合并症，包括重度PH，因髋部骨折就诊。多学科协作对于术前优化至关重要，包括输血、停用抗血栓药物以及开始血栓预防。麻醉管理包括使用脊髓麻醉并预防性插入硬膜外导管、低剂量高压布比卡因以及持续监测以预防血流动力学不稳定。术后，患者在外科重症监护病房接受密切监测。本病例突出了在急诊骨科手术中为重度PH优化结局时精心规划和积极监测的必要性。
