These can be done with either a GA or a spinal- there appears to be no mortality benefit of one over the other. The key is to deliver one excellent anaesthetic and not do a combination of the two.
Pre-op
- Check they have been reviewed by ortho geris team
- There are very few reasons to delay*
- Check G&S
Peri-op
- Induce with small cannula, site 16G asleep
- Propofol + remifentanil TCI (often need very low levels)
- Processed EEG to avoid burst suppression
- Atracurium
- ETT
- Suprainguinal fascia iliaca block
- US guided, 1mg/kg bupivicaine, made up to 30ml
- MAP >65 mmHg, or +/- 20% baseline using metaraminol infusion
- TXA 1g
- Fentanyl ~ 100mcg
- Consider cell salvage
- Check Hb with Hemocue/ blood gas before end
Post-op
- Define targets
- Transfusion threshold
- BP target
*Reasons to delay
- Hb <80
- Na <120 or >150
- K <2.8 or >6
- Uncontrolled diabetes
- Uncontrollable or acute onset LVF
- Correctable cardiac arrythmia with ventricular rate >120
- Chest infection with sepsis
- Reversible coagulopathy
Anaesthetic Recipes 