NOF AAGBI 2020 Guidelines

Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists.

Anaesthesia 2021

http://www.ncbi.nlm.nih.gov/pubmed/33289066

https://doi.org/10.1111/anae.15291

Notes

Surgery within 36 hours.

Routine use of nerve blocks to supplement GA and spinal.

Careful delivery of anaesthesia probably more important than type (GA/Spinal).

Single shot nerve block may be repeated after 6 hours.

"Do not attempt resuscitation decisions" = ?

Use risk assessment tools and scores.

Bone cement implantation syndrome. Complications in 20%, severe complications 2%, cardiorespiratory arrest in 0.5%.

Participate in audit and regional review networks.

Abstract

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.