Special Concerns in Rehabilitation

Brief History. B.W., a 75-year-old woman, fell at home and experienced a sudden sharp pain in her left hip. She was unable to walk and was taken to a nearby hospital where x-ray examination showed an impacted fracture of the left hip. The patient was alert and oriented at the time of admission. She had a history of arteriosclerotic cardiovascular disease and diabetes mellitus, but her medical condition was stable. The patient was relatively obese, and a considerable amount of osteoarthritis was present in both hips. Two days after admission, a total hip arthroplasty was performed under general anesthesia. Meperidine (Demerol) was given intramuscularly as a preoperative sedative. General anesthesia was induced by intravenous administration of thiopental (Pentothal) and sustained by inhalation of halothane (Fluothane). The surgery was completed successfully, and physical therapy was initiated at the patient s bedside on the subsequent day. 

Problem/lnfluence of Medication. At the initial therapy session, the therapist found the patient to be extremely lethargic and disoriented. She appeared confused 

Baykara N, Solak M, Toker K Predicting recovery from deep neuromuscular block by rocuronium in the elderly. 7 ClinAnesth. 2003 15 328-333. 

Bauer KP, Dom PM, Ramirez AM, O Flaherty JE. Preoperative intravenous midazolam benefits beyond anxiolysis. J ClinAnesth. 2004 16 177-183. 

Bekker AY, Weeks EJ. Cognitive function after anaesthesia in the elderly. Best Pract Res Clin Anaesthesiol. 2003 17 259-272. 

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