Walking the tightrope: Anaesthesia for fragile hearts and overactive glands in elderly hip surgery

Anesthetic management of elderly patients with ischemic heart disease, dilated cardiomyopathy with severe left ventricular dysfunction, and hyperthyroidism undergoing bipolar hemiarthroplasty presents unique challenges. Hyperthyroidism can exacerbate cardiac conditions, increasing perioperative risks. Preoperative optimization involves achieving euthyroid status using antithyroid medications and beta-blockers to control heart rate. A comprehensive cardiovascular evaluation is essential to manage heart failure and maintain hemodynamic stability. Severe pulmonary arterial hypertension further complicates anesthetic management due to increased perioperative morbidity and mortality. These patients are at higher risk for complications such as myocardial infarction and respiratory failure during anesthesia and surgery. Intraoperatively, regional anesthesia techniques may be preferred to minimize cardiovascular stress. Close monitoring of pulmonary pressures and ventricular function is crucial during the perioperative period. Postoperative care should focus on vigilant monitoring for potential complications, including thyroid storm, cardiac events, and exacerbation of pulmonary arterial hypertension. A multidisciplinary approach involving anesthesiologists, cardiologists, pulmonologists, and surgeons is essential to enhance surgical outcomes in such high-risk patients. In this case report, we present the combination of lumbar and sacral plexus blocks that we applied as the sole anesthesia method in a high-risk patient with multiple comorbidities undergoing bipolar hemiarthroplasty surgery.