Continuous Spinal Anaesthesia for Hip Fracture Surgery in a High-Risk Patient

Aksoy, Mehmet; Çömez, Mehmet Selim; İnce, İlker; Ahıskalıoğlu, Ali; Mısırlıoğlu, Mesut

doi:10.5152/tjar.2014.14227

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Other case reports exist describing the use of intrathecal catheters for lower limb arthroplasty in high‐risk patients. However, higher doses of local anaesthetic are used [10]. The utilisation of an intrathecal catheter provides the anaesthetist with the flexibility of incremental dosing to achieve the correct block height for surgery with concurrent monitoring of any haemodynamic changes.…”

Section: Discussionmentioning

confidence: 99%

Ultra‐low‐dose spinal anaesthesia for elective hip arthroplasty in a patient with severe pulmonary hypertension

Barnwell

Padfield

2020

Anaesthesia Reports

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Pulmonary hypertension is a complex chronic cardiopulmonary disease. The condition is an independent riskfactor for peri-operative morbidity and mortality in patients undergoing non-cardiac surgery, with mortality rates of up to 18%. Due to this, patients with pulmonary hypertension are frequently counselled against undergoing all but essential surgery. In this report, we describe the use of ultra-low-dose spinal anaesthetic delivered via intrathecal catheter to allow a patient with severe pulmonary hypertension to safely undergo an elective primary hip arthroplasty for osteoarthritis which was causing intolerable pain. The use of an intrathecal catheter avoided general anaesthesia in a patient who may not have tolerated positive pressure ventilation. The technique also allowed the use of ultra-low doses of spinal anaesthesia, with the option of titrating to effect and duration of surgery. Invasive monitoring allowed proactive management of the haemodynamic effects of neuraxial anaesthesia, specifically the fall in systemic vascular resistance that may be associated with higher doses of spinal anaesthesia. While this report describes a patient with severe pulmonary hypertension, the technique may also be considered for patients with other obstructive cardiac lesions including severe aortic or mitral stenosis.

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Section: Discussionmentioning

confidence: 99%

Ultra‐low‐dose spinal anaesthesia for elective hip arthroplasty in a patient with severe pulmonary hypertension

Barnwell

Padfield

2020

Anaesthesia Reports

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“…Continuous spinal anesthesia has been used successfully in hip arthroplasty [66][67][68][69][70][71] and cesarean section [72,73] in patients with severe PH or aortic stenosis and demonstrated minimal hemodynamic changes and adequate post-op analgesia. Besides neuraxial techniques, single shot or continuous lumbar plexus and sciatic nerves blockade have been used for lower extremities surgeries [74].…”

Section: Choice Of Anesthesia For Non-cardiac Surgerymentioning

confidence: 99%

Veno-Arterial Extracorporeal Membrane Oxygenation Rescue in a Patient With Pulmonary Hypertension Presenting for Revision Total Hip Arthroplasty: A Case Report and Narrative Review

Zhang¹,

Gala²,

Lementowski³

et al. 2022

Cureus

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Patients with pulmonary hypertension (PH) are at an increased risk of perioperative morbidity and mortality when undergoing non-cardiac surgery. We present a case of a 57-year-old patient with severe PH, who developed cardiac arrest as the result of right heart failure, undergoing a revision total hip arthroplasty under combined spinal epidural anesthesia. Emergent veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) was undertaken as rescue therapy during the pulmonary hypertensive crisis and a temporizing measure to provide circulatory support in an intensive care unit (ICU). We present a narrative review on perioperative management for patients with PH undergoing non-cardiac surgery. The review goes through the updated hemodynamic definition, clinical classification of PH, perioperative morbidity, and mortality associated with PH in non-cardiac surgery. Pre-operative assessment evaluates the type of surgery, the severity of PH, and comorbidities. General anesthesia (GA) is discussed in detail for patients with PH regarding the benefits of and unsubstantiated arguments against GA in non-cardiac surgery. The literature on risks and benefits of regional anesthesia (RA) in terms of neuraxial, deep plexus, and peripheral nerve block with or without sedation in patients with PH undergoing non-cardiac surgery is reviewed. The choice of anesthesia technique depends on the type of surgery, right ventricle (RV) function, pulmonary artery (PA) pressure, and comorbidities. Given the differences in pathophysiology and mechanical circulatory support (MCS) between the RV and left ventricle (LV), the indications, goals, and contraindications of VA-ECMO as a rescue in cardiopulmonary arrest and pulmonary hypertensive crisis in patients with PH are discussed. Given the significant morbidity and mortality associated with PH, multidisciplinary teams including anesthesiologists, surgeons, cardiologists, pulmonologists, and psychological and social worker support should provide perioperative management.

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“…In addition, epidural catheterization provided better postoperative analgesia management and for long-term rehabilitation. Continuous spinal anesthesia (CSA) is an another technique which can be preferred, because this technique provides well balanced hemodynamic stability and anesthesia [9]. But we didn't perform CSA since our postoperative analgesia team does not have enough experience in CSA catheter treatment during the postoperative period.…”

Section: Journal Of Clinical and Analytical Medicinementioning

confidence: 99%

Anesthesia management for ALS and WPW

Çiftçi¹,

Ekinci²,

Karakaya³

et al. 2018

Ann Clin Anal Med

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Epidural anesthesia can provide anesthesia and analgesia for unilateral or bilateral lower extremity surgery and is associated with a low complication rate. We present our epidural anaesthetic management of a patient with both Amyotrophic lateral sclerosis (ALS) and Wolff-Parkinson-White (WPW) syndrome after intertrochanteric femur fracture surgery. It should be kept in mind that the choice of correct anaesthetic method in such patients with complicated neurological, pulmonary, and cardiac symptoms will significantly reduce postoperative mortality and morbidity.

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Continuous Spinal Anaesthesia for Hip Fracture Surgery in a High-Risk Patient

Cited by 3 publications

References 8 publications

Ultra‐low‐dose spinal anaesthesia for elective hip arthroplasty in a patient with severe pulmonary hypertension

Ultra‐low‐dose spinal anaesthesia for elective hip arthroplasty in a patient with severe pulmonary hypertension

Veno-Arterial Extracorporeal Membrane Oxygenation Rescue in a Patient With Pulmonary Hypertension Presenting for Revision Total Hip Arthroplasty: A Case Report and Narrative Review

Anesthesia management for ALS and WPW

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