[Perioperative Management of Elderly Patients Over 90 Years of Age with Femoral Neck/Trochanteric Fracture].

BACKGROUND: The use of anesthesia in patients older than 90 years has been increasing. We examined the perioperative management of these patients. METHODS: The perioperative complications, waiting period for surgery, method of anesthesia, and prognosis in patients older than 90 years undergoing operations for femoral neck/trochanteric fractures were retrospectively examined in our anesthesia database. RESULTS: The average age of patients was 94.0±2.8 years. All patients had preoperative complications, including hypertensive disease (91.7%), renal dysfunction, anemia, or dementia. The average waiting period for surgery was 3.7±2.1 days; 92.6% of the patients underwent surgery within 7 days and 40.7% within 2 days. The main reason for waiting was withdrawal of antiplatelet and anticoagulant drugs. Local anesthesia, including spinal and epidural anesthesia, was used in 77.8% of patients. General anesthesia was selected for those patients on hemodialysis and continuous antiplatelets/anticoagulants. Hypotension was observed in 63.0% of the patients. The postoperative course was satisfactory, with the exception of 2 patients who died within 3 months from pneumonia and heart failure, respectively. CONCLUSIONS: Anesthetic management of the patients was without major complications. Anesthesia, either general or local, was performed safely. Further study of the relative advantages of anesthetic methods is required.

Perioperative management of factor XI deficiency in a patient undergoing hip arthroplasty.

Factor XI deficiency, or hemophilia C, is a rare autosomal recessive bleeding disorder often diagnosed by inappropriate bleeding associated with trauma or a surgical procedure, and reports of anesthetic management of this disorder are rare. We experienced an 85-year-old man with femoral neck fracture who was diagnosed preoperatively with factor XI deficiency based on abnormally long activated partial thromboplastin time (APTT). He was scheduled for bipolar hip arthroplasty and was prepared for surgery by transfusion of fresh frozen plasma (FFP), instead of factor XI concentrates, which are not commercially available in Japan. Five units of FFP were transfused 6 days before surgery, and 10 units of FFP with 2 units of red concentrated cells (RCC) were used on the day of surgery. Transfusion of FFP shortened the APTT to a level sufficient to allow hemostasis, although not to within the normal range. Although the patient required transfusion of 2 units of RCC postoperatively, no bleeding complications occurred. For bipolar hip arthroplasty, transfusion of FFP produced sufficient hemostasis without the use of tranexamic acid, factor VII preparations, or desmopressin.