Perioperative Anaesthetic Management of Severe Aortic Stenosis with Anticipated Difficult Airway in Geriatric Hip Fracture Surgery: A Case Report

Aortic Stenosis (AS) is a high-risk valvular condition associated with significant perioperative morbidity during non-cardiac surgery, especially in elderly patients. Anaesthetic management is quite difficult due to fixed cardiac output, dependence on preload, and intolerance to tachycardia or hypotension. The presence of multiple comorbidities and difficult airway further increases perioperative risk. We report the anaesthetic management of a 73-year-old male with severe AS (aortic valve area 0.8 cm², mean gradient 40 mmHg), diabetes mellitus, hypertension, and anticipated difficult airway, who underwent elective proximal femoral nailing for intertrochanteric fracture. Preoperative evaluation revealed preserved left ventricular systolic function with electrocardiographic ischaemic changes. A properly planned general anaesthesia technique was adopted using etomidate-based induction, invasive haemodynamic monitoring, controlled airway management using video laryngoscopy, and regional analgesia via ultrasoundguided fascia iliaca block. Intraoperative haemodynamics were maintained within normal limits with judicious fluid therapy, opioid supplementation, and beta-blocker titration. The postoperative period presented with transient delirium, which was managed successfully with dexmedetomidine infusion. The patient had an uneventful recovery and was discharged on postoperative day five. This case study underlines the significance of meticulous anaesthetic planning after thorough assessment and perioperative cardiovascular monitoring for elderly individuals with multiple comorbidities undergoing non-cardiac procedures, especially when complicated by difficult airway