Continuous Spinal Anesthesia With Hypobaric Tetracaine for Hip Surgery in a Patient with Severe Aortic Stenosis

Spinal anesthesia in patients with severe AS is considered by many to be contraindicated due to concerns of decrease in systemic vascular resistant that could lead to severe hypotension. A few case reports in the past have... [ view full abstract ]

Spinal anesthesia in patients with severe AS is considered by many to be contraindicated due to concerns of decrease in systemic vascular resistant that could lead to severe hypotension. A few case reports in the past have shown successful use of continuous spinal anesthesia in patients undergoing hip surgery with aortic stenosis. In this case, our patient has severe AS w/ AVA 0.8cm2 along with other co-morbidities and is scheduled to undergo R hip hemiarthroplasty. After discussing with the surgical team the procedure length and complexity, general anesthesia was deemed to carry a higher risk of complications (hypotension, emergence delirium, inability to titrate anesthetic) compared to a carefully administered spinal anesthetic. For the procedure, patient was placed in the lateral position and an intrathecal catheter was placed for gradual administered hypobaric tetracaine. The patient was sedated using a low dose propofol infusion and a low dose phenylephrine infusion was titrated to maintain mean arterial pressure at near pre-spinal levels.  No wide fluctuation in blood pressure or pulse was observed. Patient had stable hemodynamics throughout the procedure and recovered in PACU uneventfully.