Anaesthesia for a patient with severe cardiorespiratory disease.

A 76-year-old, 45 kg female, with severe aortic stenosis, angina, paroxysmal atrial fibrillation (AF), osteoporosis and asthma presented for a left dynamic hip screw for a fractured neck of femur. She was short of breath at rest with audible wheeze. She had 3 pillow orthopnoea and a hiatus hernia. She was taking frusemide 80 mg daily, amiodarone 200 mg daily, isosorbide mononitrate 25 mg daily, salbutamol and steroid inhalers, and gaviscon. She had an O2 saturation of 88% on air, biventricular cardiac failure, an ejection systolic heart murmur loudest in the aortic area radiating to the carotids, widespread expiratory wheeze and severe kyphosis.