iajabmsIAJABMSIAJABMS2709-329810.47310/iajabms.2025.v06i01.011Anaesthetic Management of a High-Risk Elderly Patient with Post-Tubercular Lung Collapse Undergoing Bimalleolar Fracture Fixation in a Peripheral Setting Without ICU BackupWe report the successful anaesthetic management of a 62-year-old female with a bimalleolar fracture and chronic left upper lobe collapse due to sequelae of pulmonary tuberculosis. The surgery was performed at Zonal Hospital, Dharamshala—a peripheral healthcare facility without intensive care unit (ICU) support. A combined spinal-epidural (CSE) anaesthetic technique was used to avoid the risks associated with general anaesthesia in a patient with severely compromised pulmonary reserve. This case underscores the importance of careful preoperative optimization and vigilant perioperative care in managing high-risk patients in resource-limited settings [1,2].