General anaesthesia should be adjusted for age and depth, using a depth of anaesthesia monitor or nomogram.
Older patients with hip fracture are sensitive to the cardiovascular effects of general anaesthesia .
Hypotension is more common during general anaesthesia than spinal anaesthesia for hip fracture repair .
Reducing the amount of general anaesthesia administered reduces the prevalence of hypotension .
Depth of anaesthesia monitoring should be used for all hip fracture patients undergoing GA because it allows for dose reduction, resulting in less prevalent hypotension [4-7].
A Lerou nomogram can also be used to administer agwe-appropriate doses of inhalational anaesthesia .
Balanced anaesthesia involving general anaesthesia + nerve block further reduces the MAC/MIC of general anaesthesia.
Inhalational induction of anaesthesia (2% sevoflurane in 100% oxygen) or use of a 10-20mg propofol ‘primer’ before a reduced iv induction dose of propofol are relatively cardiostable induction techniques [9-11].
Research is urgently needed comparing spontaneous ventilation via a laryngeal mask (risking aspiration, hypercarbia) and mechanical ventilation via an endotracheal tube (risking pulmonary complications) in hip fracture patients.
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