Elderly Hip Fracture with Pulmonary Hypertension and Advance Directive

Your regular orthopaedic surgeon informs you they have added a trauma patient to their elective list tomorrow. The patient is an 82-year-old woman requiring a total hip replacement for a sub-capital neck of femur fracture from a mechanical fall. The patient lives in a granny flat attached to her daughter's home. She tripped on her bedroom door stopper. Her past medical history includes: Chronic obstructive airway disease - 50 pack years of smoking cigarettes, ceased 6 months ago Atrial fibrillation diagnosed 2 years ago - recent echocardiogram shows RVSP 65 mmHg Medications Formoterol 12 mcg every 6 hours, as required Indacaterol/glycopyrronium 110/50 mcg once daily Apixaban 2.5 mg bd Digoxin 62.5 mcg once daily Furosemide 20 mg once daily Spironolactone 50 mg once daily Escitalopram 10 mg once daily Current observations HR 112 bpm BP 89/60 mmHg SpO2 94% on room air RR 20 breaths per min Weight 60 kg Height 155 cm BMI 25 kg/m2 VAS pain score 8 out of 10 (after 2.5 mg oxycodone IR 30 min ago) The patient and family wish to discuss her anaesthetic risks.