Continuous Spinal Anesthesia for Hip Fracture Surgery in a very Old Patient With Pulmoner Hypertension

Abstract

Elderly patients have increased risk for perioperative and postoperative mortality and morbidity due to additional comorbidities, such as cardiac diseases. Anesthesia and surgery in patients with pulmonary hypertension (PH) are associated with high perioperative morbidity and mortality, and elective surgeries should generally be avoided fort this reason. Anesthesia and surgery are associated with significantly increased morbidity and mortality in patients with PH due mainly to right ventricular failure, arrhythmias, postoperative hypoxemia, and myocardial ischemia. Regional anesthesia techniques are usually preferred in high-risk patients due to some advantages, such as the maintenance of cardiovascular stability and early postoperative mobilisation. This case presents the anaesthetic approach in a 87-year-old male patient with atrial fibrilation, chronic obstructive pulmonary disease and pulmonary hypertension who underwent hip fracture surgery. In the present case, continuous spinal anesthesia with low-dose hyperbaric bupivacaine provided safe and effective anaesthesia during surgery with minimal haemodynamic changes and analgesia during the first 24 hours after surgery.