Anesthetic Management of an Urgent Hip Fracture Repair in a Nonagenarian With Critical Aortic Stenosis

Severe aortic stenosis presents substantial anesthetic risk because fixed left ventricular outflow obstruction limits the ability to compensate for perioperative hemodynamic changes. These risks are further amplified in elderly patients with additional valvular disease and limited physiologic reserve who require urgent noncardiac surgery. We report the anesthetic management of a 96-year-old woman with critical aortic stenosis and concomitant mitral valve disease who required urgent hip fracture repair. Preoperative echocardiography demonstrated severe valvular calcification with a markedly reduced aortic valve area and elevated transvalvular gradients consistent with critical aortic stenosis. General anesthesia was induced with etomidate and fentanyl, with invasive arterial monitoring and phenylephrine infusion utilized to maintain coronary perfusion pressure and hemodynamic stability throughout the procedure. Multimodal postoperative pain management and close postoperative monitoring were employed to facilitate recovery while minimizing cardiovascular stress. The patient tolerated the procedure without intraoperative hemodynamic instability and experienced an uncomplicated postoperative recovery. This case illustrates key physiologic principles in the anesthetic management of severe aortic stenosis and highlights the importance of multidisciplinary decision-making and shared informed consent when high-risk patients require urgent surgical intervention.