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Updated: Jan 13, 2026

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Between a Rock and a Hard Place: Hip Fracture Repair in an Elderly Patient with Severe Cardiac Comorbidities and
Mary E Arthur1, Prathik Mudaliar, Ashish Sakharpe
1From the Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia.
Abstract:
Perioperative right ventricular dysfunction can be life-threatening. Anesthetic management of elderly patients with hip fractures and advanced cardiac disease poses considerable perioperative risks. The problem-based learning discussion examines the management of an 87-year-old female with severe pulmonary hypertension, right ventricular dysfunction, and recent anticoagulation scheduled for urgent hip fracture repair. A tailored management approach included peripheral nerve blocks, intraoperative transesophageal echocardiographic monitoring, goal-directed hemodynamic support, and management of acute RV decompensation with intratracheal milrinone and inhaled epoprostenol. It presents strategies for high-risk geriatric trauma patients, individualized anesthetic planning, and the role of pulmonary vasodilators.
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