Anesthetic Management for Emergency Orthopedic Surgery in a Patient with COPD and Asthma: A Case Report

Orthopedic trauma patients with limited mobility and prolonged bed rest are at high risk of venous thromboembolism and pulmonary embolism (PE). When acute hypoxemia and respiratory dysfunction occur in such patients, it is clinically challenging to distinguish PE from acute exacerbation of underlying chronic obstructive pulmonary disease (COPD) or asthma, which directly affects perioperative safety. This study aimed to summarize the diagnostic thinking and standardized anesthetic management strategies for this type of high-risk emergency patient. We reported a 68-year-old male patient diagnosed with L2 burst fracture, who presented with severe hypoxemia (room-air SpO 2 75%) before emergency surgery. Combined with the patient’s medical history, lung auscultation, arterial blood gas analysis and chest computed tomography (CT) findings, we rapidly confirmed that hypoxemia was caused by acute airway obstruction rather than PE. Pre-intubation interventions including bronchodilators, corticosteroids and airway surface anesthesia were applied to prevent intraoperative bronchospasm. Intraoperative lung-protective ventilation was implemented, and stepwise respiratory support was adopted after extubation. The patient had an uneventful perioperative course and was discharged on the 5th postoperative day. In conclusion, for immobilized orthopedic trauma patients complicated with chronic airway diseases and acute respiratory abnormalities, comprehensive differential diagnosis combining clinical manifestations and auxiliary examinations is the premise of safe treatment. Targeted pre-operative prevention, standardized intraoperative ventilation and graded postoperative respiratory care can effectively reduce perioperative respiratory complications.