PERIOPERATIVE MANAGEMENT OF AN ELDERLY PATIENT WITH INTERTROCHANTERIC FEMUR FRACTURE COMPLICATED BY PULMONARY EMBOLISM AND ATRIAL FIBRILLATION: A CASE REPORT

Abstract

To report the perioperative management of an 83-year-old male who presented with femur intertrochanteric (IT) fracture, who then developed pulmonary embolism in the background of atrial fibrillation. The patient had preoperative delirium, which was managed with haloperidol. The surgery was done under general anesthesia, with intensive hemodynamic monitoring via arterial line, vasopressor support, and a restrictive fluid strategy. Blood loss replaced by blood transfusion rather than crystalloids. Clexane 0.4 mg subcutaneously was administered as prophylactic anticoagulation for pulmonary thrombosis. For pain relief, postoperative analgesia with USG-guided femoral nerve block using 0.5% bupivacaine was given. Despite advanced age, pulmonary embolism, atrial fibrillation, anemia, and delirium, the patient recovered and became cooperative and oriented. He was shifted to the ward after two days of observation. This case enlightens us about the importance of early recognition, multidisciplinary management, restrictive fluid therapy, anticoagulation and multimodal analgesia in optimizing outcomes in high-risk geriatric surgical patients.