ABSTRACT
This case report details the perioperative challenges and anesthesia strategies in managing severe pulmonary hypertension (PH) during emergency orthopedic surgery. An 86-year-old male with multiple comorbidities, including severe PH, presented with a hip fracture. Multidisciplinary collaboration was crucial for preoperative optimization, including transfusions, antithrombotic discontinuation, and thromboprophylaxis initiation. Anesthesia management included the use of spinal anesthesia combined with a precautionary epidural catheter insertion, low-dose hyperbaric bupivacaine, and continuous monitoring to prevent hemodynamic instability. Postoperatively, the patient was closely monitored in the surgical intensive care unit. This case highlights the necessity of meticulous planning and proactive monitoring in optimizing outcomes for severe PH in emergency orthopedic surgery.