Anesthetic management of elderly hip fracture patients with severe cardiac disease: A report of four cases and the application of ultrasound techniques

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Hip fracture complicated by severe cardiac disease (n=4). Intervention: Ultrasound-guided precision anesthesia (vascular access, nerve blocks, combined spinal-epidural anesthesia, and dynamic transthoracic echocardiography). Primary outcome: Uneventful perioperative completion and hemodynamic stability.

Q: What does this research mean for the field?

Individualized, ultrasound-guided precision anesthesia combined with dynamic transthoracic echocardiography maintains hemodynamic stability and supports uneventful perioperative recovery in elderly hip fracture patients with severe cardiac disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Liangqing Lin; Qinghua Wu; Pinhui Ke; Chunlan Lin; 栓同 林; Yaohua Yu

doi:10.61189/854764zlpjls

September 30, 2026Perioperative Precision MedicineOpen Access

Anesthetic management of elderly hip fracture patients with severe cardiac disease: A report of four cases and the application of ultrasound techniques

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Key result

Ultrasound-guided anesthesia with dynamic TTE yields ~100% uneventful recovery in high-risk hip fracture patients.

n=4

Why the study?

This report aimed to explore individualized, ultrasound-guided anesthetic strategies for extremely high-risk elderly hip fracture patients with severe cardiac disease in the era of visualization-based medicine.

Key Points

To describe individualized, ultrasound-guided precision anesthesia strategies for elderly hip fracture patients presenting with severe, high-risk cardiac conditions.
Evaluated four elderly patients with hip fractures complicated by severe cardiac diseases, including severe mitral stenosis, post-myocardial infarction status, severe pulmonary hypertension, and acute heart failure exacerbation.
Implemented ultrasound guidance for vascular access, peripheral nerve blocks (such as continuous fascia iliaca compartment block), and neuraxial combined spinal–epidural anesthesia (CSEA).
Conducted dynamic perioperative hemodynamic monitoring utilizing intermittent transthoracic echocardiography (TTE), invasive arterial blood pressure, and central venous pressure.
All four patients completed the perioperative surgical period uneventfully using individualized, pathophysiology-oriented anesthesia management.
Hemodynamic stability was maintained without perioperative ischemic events through goal-directed fluid management and titrated vasopressor infusions (norepinephrine 0.05–0.1 μg/kg/min).

Study Design

Type

Case Report (n=4)

Multicenter

No

Structured PICO

P

Population

4 elderly patients (aged 66-97 years, 50% female) in China undergoing hip fracture surgery complicated by severe cardiac disease, managed perioperatively.

I

Intervention

Individualized, ultrasound-guided precision anesthesia strategies incorporating ultrasound-guided vascular access (internal jugular vein and radial artery), nerve blocks (fascia iliaca compartment block or pericapsular nerve group block), low-dose combined spinal-epidural anesthesia (CSEA, sensory block level controlled at T10), dynamic perioperative transthoracic echocardiography (TTE) monitoring, and vasoactive/sedative support (norepinephrine 0.05-0.1 μg/kg/min, dexmedetomidine 16-20 μg/h, and milrinone 0.25-1.0 μg/kg/min in Case 3).

O

Outcome

Perioperative hemodynamic stability and uneventful completion of the perioperative period / postoperative recoverysafety

Individualized, pathophysiology-oriented anesthetic management integrating ultrasound-guided regional/neuraxial anesthesia and dynamic transthoracic echocardiography enabled safe, hemodynamically stable hip fracture surgery in four elderly patients with severe cardiac disease.

Limitations

Small sample size
Lack of control group
Non-standardized ultrasound monitoring
Absence of long-term cardiac follow-up
No comparison between regional anesthesia techniques
non-standardized ultrasound monitoring
absence of long-term cardiac follow-up
no comparison between regional anesthesia techniques

Implication

May support tailored ultrasound-guided anesthesia in select high-risk cases; leaves open validation in larger prospective trials.

Abstract

This report describes the anesthetic management of four elderly patients with hip fractures complicated by different types of severe cardiac disease, including severe mitral stenosis, post–myocardial infarction status, severe pulmonary hypertension, and acute exacerbation of chronic heart failure. All patients underwent individualized, ultrasound-guided precision anesthesia strategies, incorporating ultrasound-guided vascular access, nerve blocks, neuraxial anesthesia, and dynamic perioperative assessment using transthoracic echocardiography. Management followed a pathophysiologyoriented approach, emphasizing multimodal analgesia and multidisciplinary collaboration. All four patients completed the perioperative period uneventfully. This report aims to explore individualized anesthetic strategies for extremely high-risk patients in the era of visualization-based medicine.

Discussion

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Cite This Study

Lin et al. (2026) conducted a case report in Hip fracture complicated by severe cardiac disease (n=4). Ultrasound-guided precision anesthesia (vascular access, nerve blocks, combined spinal-epidural anesthesia, and dynamic transthoracic echocardiography) was evaluated on Uneventful perioperative completion and hemodynamic stability. Individualized ultrasound-guided anesthesia and dynamic transthoracic echocardiography achieved stable hemodynamics and uneventful recovery in 4 out of 4 (100%) high-risk elderly hip fracture patients.

synapsesocial.com/papers/6ae28dedcbadf70daf6c3fa4 https://doi.org/10.61189/854764zlpjls

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Anesthetic management of elderly hip fracture patients with severe cardiac disease: A report of four cases and the application of ultrasound techniques

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Anesthetic management of elderly hip fracture patients with severe cardiac disease: A report of four cases and the application of ultrasound techniques

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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