Anesthesia for Fractured hip

[CaliDreamin4Life]

What factors do you all use to determine if you do a spinal vs. GA vs. Epidural for the 'emergency hip patient' who presents to you on call. Often older patient, sometime on blood thinners, in a lot of pain for regional positioning, etc? I didn't get much experience with this situation in residency and want to know what you are doing and why. Also, intrapoperative issues. Do you feel like you have less hemodynamics control if you do a spinal and there's major blood loss? Thanks in advance.

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[OB1🤙]

GA/LMA

Fascia iliaca block if I'm feeling frisky, which I'm usually not. They do fine without.

 

[OB1🤙]

For full stomach or hemiarthroplasty, ETT.

 

[pgg]

Lots of threads on this in the past.

If on anticoagulants, GA. (Though warfarin takers often get vit K and FFP from the surgeon before we even get called.) Go to sleep on transport bed, move to table after patient is asleep. I prefer intubation over LMAs. Typically don't use any relaxant. Will do a fascia iliaca block after they're asleep, it's fast/easy and it works.

Otherwise usually a spinal. 20 or 30 mg of ketamine prior to positioning, broken hip up. Isobaric bupivacaine, the 0.5% MPF stuff in the vial that says "not for spinal use" ...

I'll often put a very low dose phenylephrine infusion on a pump to keep their BP near baseline.

 

[CaliDreamin4Life]

I worry about occult cardiac disease as well regarding spinal sympathectomy. Re: dementia, I thought the current buzz word 'POCD' would make one lean towards spinal if no contraindication in the elderly? Why hypobaric bupivicaine? Thanks all.

 

[deleted126335]

I find that the demented often need a fair amount of sedation to keep them from being uncooperative.

 

[Planktonmd]

LMA!

 

[Numbex]

Agree with pgg- isobaric bupiv after 25 mg of ketamine with 0.5 to even 2 mg of Versed. If needed you can run a little propofol etc later. Why isobaric or hypobaric? You put the spinal in lateral with broken side up, probably make the broken side more numb and that's just fine.

 

[Trisomy13]

Agree with pgg- isobaric bupiv after 25 mg of ketamine with 0.5 to even 2 mg of Versed. If needed you can run a little propofol etc later. Why isobaric or hypobaric? You put the spinal in lateral with broken side up, probably make the broken side more numb and that's just fine.