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Background and Aims anaesthesiologists who manage trauma are frequently required to provide timely anaesthesia for patients undergoing surgical repair of hip fractures. Morbidity and mortality rise sharply if surgery is delayed for more than 48 hours, with some societies recommending surgery within 36 hours. Correctable arrhythmias with a ventricular rate over 120 beats per minutes are considered a reasonable a reasonable indication to postpone surgery. The degree of delay is undefined, but can be 24 hours or more. We present two cases of new onset fast atrial fibrillation managed in the theatre complex, resulting in minimisation of delay before surgery.

Methods Both patients presented to our emergency department with hip fractures following witnessed mechanical falls at home. Admission ECGs demonstrated normal sinus rhythm. Ward reviews by orthogeriatric and anaesthesia teams did not reveal any new cardiac issues. On application of monitors in theatre, both patients had rapid irregular rythyms without discrete P waves. Atrial fibrillation was confirmed with 12 lead ECGs. Both patients were treated with IV lidocaine, Magnesium, fluids, and Amiodarone and monitored in the theatre complex while their condition improved.

Results Both patients conditions improved to the point where it was felt reasonable to proceed with surgery. Neither patient suffered further complications, and both survived to discharge and follow up with orthopaedics.

Conclusions It is reasonable to consider managing new onset fast atrial fibrillation discovered in theatre. This strategy may have benefits to patients through reduced waiting times to surgical repair, and to the healthcare system through efficient use of skills and resources available.