Patient: Female, 107Final Diagnosis: Hip fractureSymptoms: —Medication: —Clinical Procedure: Hip surgerySpecialty: Orthopedics and TraumatologyObjective:Rare diseaseBackground:In modern societies, elderly populations have increased over the last four decades and have become the main clients of medical services. A hip fracture is a significant injury for anyone, but for older people it can be catastrophic.Case Report:A 107-year-old female was admitted with fracture of the right hip. The patient took a single 200 mL carbohydrate drink orally two hours before surgery. Before induction of spinal anesthesia, routine monitoring was started and an intravenous line was placed. Crystalloids and hydroxyethyl starch in 0.9% sodium chloride solution were administered intravenously during the operation. After sedation with i.v. ketamine and midazolam, spinal puncture was performed with the patient in the sitting position and isobaric bupivacaine were administered. The level of sensory block was observed in T12 and motor blockade (grade 3) of the lower limbs. The surgical procedure lasted 60 minutes without hypotension, bradycardia or decreased oxygen saturation. For safety reason, the patient was transferred to the ICU for monitoring; intravenous hydration was withdrawn and released oral feeding six hours after the end of surgery. The patient was sent to his residence on the morning of the second day.Conclusions:This case showed that with suitable techniques and conduits can perform surgery in a patient with 107 years.

sufficient sedation to maintain the patient in position for posterior brachial plexus block and for the relief of pain in 55% of them during the procedure, without hemodynamic variation. 8 This prospective and observational study was performed to evaluate the clinical effectiveness of posterior brachial plexus access with a single injection of the combination of lidocaine and enantiomeric excess levobupivacaine with neurostimulator in patients undergoing clavicle, shoulder and proximal chair procedures of beach associated with general anesthesia. Methods The study was submitted and approved by the Ethics Research Committee (Number 05787/2014) and all patients were explained the method and obtained their consent by signing the informed consent form. The study was conducted between January 2015 to December 2018 with 50 patients of physical status I and II (ASA) of both sexes who underwent elective clavicle, shoulder and proximal humeral procedures in beach chairs associated with general anesthesia. The protocol was registered in the Brazil Platform (CAAE: 33373214.1.0000.5179). As part of Program ACERTO, all patients drank a single 200 mL liquid oral hypercaloric nutritional supplement (1.5 Kcal /mL) without residue, clarified and without addition of lipid and fiber (Fresubin Jucy®) about 2 to 4 hours before surgery. The sample size was based on the conservative calculation the population size of 95% and with a margin of error of 10%, obtaining the number of 50 patients, ages 18 to 60 years, weighing 60 to 80 kg, 160 to 180 cm tall. Exclusion criteria for posterior brachial plexus block were the presence of allergy to local anesthetics, bronchopulmonary disease, coagulopathy or neurological diseases with brachial plexus damage and emergency or classified surgery patients as class III or more of ASA physical state. All the blocks were performed using the landmarks as Figure 1.

Background: The WHO considers elderly as an individual who is ≥ 60 y of age, and there are ≥ 37.7 million elderly people. In 2006, the ACERTO Project (Acceleration of Total Post-Operative Recovery) was introduced in Brazil in colorectal surgeries, and in elderly orthopedic femur fractures in 2010, with primary objective for the patient to early return to independent life. The objective of this descriptive study is to evaluate the clinical results 870 elderly patients undergoing surgical treatment of femoral fractures in ten years (2010-2019) after employing the perioperative acceleration protocol. Methodology: It was a cross-sectional, prospective study in patients ≥ 60 y, of both genders, undergoing corrective hip fracture for ten years at a hospital covered by the Brazilian Public Health System (SUS). The data regarding preoperative condition of the patients, fasting status, mode of anesthesia, drugs used, intra-operatively measured variables and immediate post-operative variables measured in the PACU, quality of lumbar plexus block analgesia, presence of delirium in the first day of postoperative was obtained from the study protocol. The deaths during the first postoperative month were noted. Results: A total of 829 patients underwent surgery for a fracture of the hip, under spinal anesthesia, of whom 583 were women and 246 were men. The average hospital stay was 10.2 ± 7.1 days, and it was associated with the age. The mean fasting time was 2:50 ± 0:32 h. The dose of isobaric bupivacaine was 9.62 ± 1:85 mg. The cephalad spread varied from T12 to T5. The duration of the spinal block was 2:50 ± 0:38 h, the time for the use of dextrinomaltose in PACU was 1:39 ± 0:47 h, the time in the PACU was 2:03 ± 0:46 h and the time to reintroduce normal meals was 6:18 ± 1:02 h. Arterial hypotension occurred in 36 (4.3%) patients, bradycardia in 4 (0.4%), and delirium in 16 patients. Eleven (1.3%) patients were sent to the ICU due to surgical problems. There were no deaths directly related to anesthesia or surgery. Conclusion: The implementation of the ACERTO Project in 829 patients with femur fracture of the Brazilian Public Health System, showed favorable results regarding length of stay, patient satisfaction, decreased use of bladder tube and drains, and referral to ICU, with early discharge to residence. Citation: Imbelloni LE, Teixeira DMP, Lima U, Ventura TB, Lacerda S, Brasileiro, Barbosa R, Sales MBL, Duarte M, Filho GBDM. Accelerated operative recovery in elderly patients with femoral fractures: Our experience of ten years with 870 patients. Anaesth. pain intensive care 2022;26(5):608-615; DOI: 10.35975/apic.v26i5.1992