This document summarizes a 39-year-old male patient who presented with an intertrochanteric fracture of the left hip. He had a history of diabetes, liver disease, splenectomy, and alcohol use. He underwent a closed reduction and internal fixation with a proximal femoral nail. The anesthetic plan addressed his comorbidities and perioperative risks. Intraoperatively, he developed ventricular tachycardia which resolved with medication. He received blood products due to blood loss. Postoperatively, he showed signs of hepatic encephalopathy.

1. Morbidity
Diagnosis- Intertrochanteric Fracture Left HIP
Procedure –CRIF with PFN nailing
Team involved:
DR.Archana Asst. Prof.
DR.Harith(PG)
Patient subash chandar
Age -39/M
Weight -40 Kg
Height – 160Cm

2. Brief History :
Diagnosis:
Surgical Procedure:
Comorbidities
K/c/o Diabetes Mellitus on Insulin
h/o Decompensated liver disease diagnosed with portal hypertension
diagnosed 3 years back
S/P splenectomy
H/o haematemesis endoscopic ligation was done 3 years back
Presented with complains of
h/o slip and fall 2 days back
Sustained injury Left Hip
No h/o head injury ,LOC
no h/o URI and LRI
No h/o any other injuries
Alcoholic for 10 years stopped 4 years back
No h/o difficulty in passing Urine or passing Stools
h/o hematemesis one episode two months back

3. Conscious
Oriented
Pallor + ICTERUS + ,No
CYANOSIS CLUBBING
LYMADNEPATHY
Hydrated
CFT <TWO SEC
Effort Tolerance 4 METS
Good Venous Acesss
PR : 112 vol: good
RR : 16
NIBP : 110/60
Temperature : afebrile
RS :B/L AE +, NVBS
CVS: S1S2 heard , no
murmurs.
PA –Soft BS+
Snoring history : no
Mouth
opening:adequate
MPC : class 1
Nasal patency : patent
Mentohyoid :3 fb
Teeth : NLT
Spine : palpable L3-L4
widest space
GPE
AIRWAY EXAMINATION
VITALS Systemic examination

4. Hb : 9.2 gms%
TC :11500 cells/cu.mm
DC : N -53.9 /L-29.3 M-
4.3 /E-2.3
Platelet count: 1.5 L
Routine investigations
Total Protein 5.9
Albumin 2.9
T.Bilirubin 6.0
Direct 3.0
AST 35
ALT 17
ALP 194
PT 17.5 sec
INR 1.61
Blood urea : 54mg/dl
S creatinine:0.72 mg/dl
Na-130
K 3.1
Cl-104

5. ANAESTHETIC PLAN
Peri-op Risk Factors
• Thin Built-
Malnourished
• S/P splenectomy
• Decompensated Liver
Disease
• Coagulopathies
• Mild Ascites
• Diabetes Mellitus
• Duration: 2hrs
• Blood loss: > 500 ml.
• Position:Lithotomy
with Watson jones
fracture table
• Hypotension
• Post op cognitive
Dysfunction
• Hepatic
Encephalopathy
• Spinal Hematoma
• Hypothermia
• Child-Pugh Score 8
Patient factors Surgical factors
Anaesthesia factors
ASA IV
NPO from night 10 pm
To reserve 2units of PRBC 4 Units FFP
Femoral block for positioning for spinal
Subarachnoid Block

6. Femoral Block given 20 ml of 1%Lignocaine with
adrenalin along with 10 ml of 0.25% Bupivacaine
Machine Checked,Emergency Drugs , Loaded
On table at 8.10 am
Connected to monitor
HR-106 IBP 106/70 Spo2 99%
R arm 16G venflon secured
Two units of FFP was Transfused
Positioned for Spinal – Spinal given with 26G Quincke
needle with 0.5% 2.5ml hyperbaric bupivacaine with
50mcg Fentanyl level T8
I
N
T
R
A
O
P

7. Inj.Mephentramine 6 + 6 with one unit 0.9% normal saline
After spinal BP 80/50 with low volume pulse
ECG showed VT with HR 130 and BP 106/62
Started on Inj.Dopamine
I
N
T
R
A
O
P
Dopamine Stopped VT reverted to Sinus Tachycardia with HR 110
Started on Inj.Noradrenalin 0.04 mcg which was tappered and stopped
Total blood loss was 500 ml 1 unit of FFP and 1 unit of PRBC was given
Patient shifted to recovery

8. POD #0
• In reovery room patient was irritable
• Patient was irritable,complaining of pain
Inj.Para 500 mg and Inj.Tramadol 50 mg given
Medicine opinion sought – Hepatic Encephalopathy