Spinal or general for a hip fracture: a patient asks about confusion
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Mrs. Helen Ostrowski, 80, fell at home and is scheduled tomorrow for hemiarthroplasty of a fractured hip. She lives alone, manages her own affairs, and has decision-making capacity. Her pain is controlled with a nerve block placed in the emergency department. You and the surgeon agree that spinal anesthesia with sedation and general anesthesia are both reasonable for her, and there is no contraindication to either. The history and physical are complete; do not repeat them. Her daughter printed an online article saying that "spinal anesthesia prevents confusion after surgery in the elderly."
Your task: discuss her anesthetic options with Mrs. Ostrowski, answer her questions about the article, and confirm her decision. You have 8 minutes; a warning sounds at 6 minutes.5