We read with great interest the much-awaited article on management of femoral neck fractures [1] and found it very useful. We have had a few incidents when patients with known atrial fibrillation had been brought to theatre for fixation of a fractured neck of femur with a normal heart rate prior to the start of anaesthesia but developed sudden onset of uncontrolled ventricular rate during surgery or in the immediate postoperative period. The contributing factor was that patients had not been given their usual medication(s) for rate control preoperatively due to a variety of reasons and then required unplanned admission to our high dependency unit postoperatively. We believe that local guidelines should emphasize that all the patient's usual medications, including the rate controlling drug, are prescribed and administered preoperatively in order that these high risk patients are not compromised any further peri-operatively and we have done this in our local guideline [2].
V.K. Mahadevan
P. Paranthaman
North Tees & Hartlepool NHS Trust
Stockton on Tees, U.K.
Email: vkmahadevan@yahoo.co.uk
No external funding and no competing interests declared.
References.
1.Griffiths R, Alper J, Beckingsale A et al. Management of proximal femoral fractures. Anaesthesia 2012; 67: 85-98
2. Corry R, Trethowan B, Franklin R et al. Introduction of a novel guideline for the administration of perioperative medicines to elective surgical patients. Anaesthesia 2012; 67, Supplement s1: 8-9