Perioperative anesthesia management in elderly patients with chest trauma following a fall: a case report

Anesthetic management of an elderly patient with a retained wooden chest foreign body for emergency thoracic surgery in a low-resource setting, complicated by recent asthma exacerbation, posed significant perioperative challenges.

A 65-year-old Ethiopian male falling from 5-meters height tree on wooden ground and was admitted to our tertiary hospital after four hours of injury on the left chest with a wooden foreign body in situ. On presentation, the patient underwent comprehensive evaluation and received initial resuscitative care. Following informed written consent, a thoracotomy under general anesthesia was subsequently planned and performed as definitive management. After multimodal medication premedication and applying standard monitoring for general anesthesia, balanced anesthesia was administered without adverse events. The impaled wood was removed cautiously under direct visualization of the surrounding organ injury, and a wedge resection was performed. Postoperatively, he was discharged from the hospital after 20 days of postoperative care with a good health condition and was appointed for medical follow-up after 2 weeks.

Falling from a certain height can cause serious harm, including comorbidities and even immediate death. Although such incidents are rare, a fall from a height can lead to musculoskeletal injuries and internal disruptions in elderly individuals, potentially resulting in concealed bleeding and organ damage. In addition to the critical nature of these emergencies, a patient's medical comorbidities present significant barriers to achieving optimal outcomes. Therefore, a recent exacerbation in an asthmatic patient undergoing thoracotomy for retained wood removal necessitates multidisciplinary team care to ensure the best possible outcomes.

Essential health care for such patients needs a multidisciplinary team approach to health care service. Furthermore, meticulous airway and optimal pain management is the mainstay in perioperative anesthesia management.