Anesthetic Management of Bilateral Neck of Femur Fracture for Bilateral Hip Arthroplasty with CKD and Seizure Disorder

Abstract

In elderly hip fractures are common presentations which require surgical intervention. These patients have increased morbidity and mortality due to associated comorbidities like renal, cardiac, respiratory, endocrine or neural diseases. Chronic kidney disease is one of the common complications of long standing uncontrolled hypertension and diabetes mellitus. Patients with CKD are exposed to an increased risk for adverse outcomes and further perioperative injuries resulting from hemodynamic instability, hypovolemia, or drug toxicity, each of which has the potential to aggravate renal dysfunction, ultimately leading to end stage renal disease, and reduced long-term survival. It is estimated that there are approximately 7.85 million chronic renal failure patients in India.1 Diabetes mellitus and hypertension reaching epidemic proportion in urban population and chronic kidney disease being inevitable in long standing untreated cases, providing anesthesia to patients with chronic kidney disease poses a challenge. Case Report: A 48yr old male presented with bilateral neck of femur fracture following fall from height and was planned for bilateral hip arthroplasty. Patient is a known case of CKD on maintenance haemodialysis. He is also a known hypertensive, diabetic and seizure disorder on treatment. Patient has underwent epidural anesthesia. Conclusion: We present a successful anesthetic management of a dwarf patient with bronchial asthma and hypothyroidism who underwent hysterectomy. We emphasize the risk of neurological injury while extending the neck during laryngoscopy for tracheal intubation due to anatomical abnormalities in these patients. A detailed pre anesthetic evaluation evaluation and planning is utmost important and the anesthetic technique has to be individualized based on the patients anatomical characterstics and associated co-morbidities.