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Cardiopulmonary Stability on a Patient with Hip Fracture and Severe Pulmonary Hypertension, Anesthetized with lumbar-sacral plexus block and Non-Invasive Ventilation: Case Report

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Open Journal of Anesthesiology 2022年第10期12卷 301-314页

作者： Uribe Campo Giselle Andrea Perales Caldera Eduardo Prol Carreiro Adolfo Velazco González Jose Gamaliel Díaz Borjón Efraín Morales Maldonado Rubén Alejandro Department of Anesthesiology Hospital ángeles Lomas México City Mexico Department of Intensive Care Hospital ángeles Lomas México City Mexico Department of Orthopaedics Hospital ángeles Lomas México City Mexico

Background: Pulmonary hypertension is defined as a mean arterial pressure in the pulmonary artery exceeding 20 mm Hg at rest, measured by means of right heart catheterization. Patients with pulmonary hypertension undergoing surgical procedures such as hemiarthroplasty present a high risk of fatal complications. Nonetheless, there are no widely accepted protocols explaining their perioperative care in great detail. Case presentation: We present a case with an 89-years-old patient, with comorbidities such as GOLD 4D chronic obstructive pulmonary disease (COPD) and, as a consequence of this, severe pulmonary hypertension with signs of right ventricular dysfunction, thus requiring of pulmonary vasodilator, that has suffered a subcapital hip fracture requiring urgent surgery. Surgery is carried out successfully, under regional lumbar-sacral plexus block and sedation assisted by non-invasive ventilation. Conclusion: Multidisciplinary specialized treatment, preoperative optimization, as well as the careful selection of both the surgical and anesthetic techniques to be used, are among the strategies that improve the perioperative outcome in patients with pulmonary hypertension with right ventricle systolic dysfunction. Regional lumbar-sacral plexus block plus sedation is a technique that maintains hemodynamic stability;however, these patients require advance measures and postoperative monitoring under intensive care.

关键词： Hip Fracture Pulmonary Hypertension lumbar-sacral plexus block Non-Invasive Ventilation Right Ventricular Failure

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