to anaesthetize or to say no

Started by jafo1964, November 30, 2012, 05:40:30 PM

Previous topic - Next topic

0 Members and 1 Guest are viewing this topic.


Just got face to face with a moral dilemma and was wondering what the anaesthetic community would decide largely on this

called into see a 92 year old man who had fallen this morning and fractured his tibia
No previous surgery or allergy or major hospitalisation. Currently he is not receiving and drugs. He may have been on some in the past but progressively discontinued all of them.

Pale looking man , surprisingly had reasonable nutritional status.
He was drowsy, semi-conscious responding to minimal painful stimuli
History of hearing loss - could be the reason for failure to respond to verbal commands
respiration , airway control and pupils were all normal
CVS parameters were stable
He had a pansystolic murmur over the praecordium
RS showed a few scattered creps

Hb was 6.5
Urea was 84 and creatinine was 4.2
Electrolytes were unremarkable with potassium at 5.0
ECG shows old IWMI

Awaiting CT scan, my guess is that it will show nothing significant except for the atrophic changes associated with aging and dementia.

Has a compound fracture of Tibia and there is a steady ooze from the wound

Prior to the fall he was restricted to his room but could move by himself

The family asks if the surgery will set him back to normal

What would you think, say and do

I am awaiting the CT  and ECHO reports but am strongly inclined to advice not to subject this gentleman for anaesthesia and surgery. The risk is high and i am not sure that it will improve the quality of life



yes to surgery.probable choice of anaesthesia spinal with titrated dose.


what did you do actually after the CT and ECHO about the oldman.?


Spinal with such a heart murmur is risky (should do a heart echo?)

Defenetely GA with i-gel, no or minimal relaxation, a bit of etomidate, Fentanyl....


Spinal or some propophol and sufenthanyl or fenthanyl with huge oxigenation should make old man feel better then awake K is up to 5 so diuresys shold be monitored


I would try to improve the condition of this patient preoperatively-infusions,correction of anaemia,adequate intravascular volume,  Echo-find out ejection fraction,pulmonary hypertension,valve function. In case of severe heart depression,CT brain -acute ischaemia,I would refuse the case. In case I would anesthetize this patient, I would discuss risk of this procedure with his family- highrisk patient, very old, complications including death. I would prefer epidural with placing catheter-unnecessary adequate iv volume.


US guided sciatic nerve block at popliteal fossa is my option