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SUBARACHNOID BLOCK WITH LOW DOSE OF BUPIVACAINE IN A PATIENT WITH SEVERE SYMPTOMATIC AORTIC STENOSIS
ESRA Academy. Ribeiro J. Sep 8, 2016; 138313
Topic: Spinal Anaesthesia - Analgesia
Dr. Jo Ribeiro
Dr. Jo Ribeiro

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Abstract
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Background and Aims:

Severe aortic stenosis (AS) has relevant implications in perioperative risk, being the only valve disease identified as having a significant risk factor in non-cardiac surgery. The anesthetic approach towards this pathology requires strict maintenance of hemodynamic goals, necessary to the preservation of cardiac output. The subarachnoid block (BSA) is traditionally contraindicated in these patients but, when running with low doses of local anesthetics, can provide excellent analgesia with cardiovascular stability.

Methods:

We describe the case of a 76 years old patient, proposed for urgent correction of femoral neck fracture, with a history of severe symptomatic AS (0.5 cm2 area, ventricular-aortic gradient 32 mmHg), severe heart failure (fraction injection 10%), ischemic heart disease and chronic kidney disease (stage IV). After invasive monitoring we proceeded to the injection of 5 mg of hyperbaric bupivacaine and 2,5 mcg of sufentanil in the subarachnoid space with the patient in the lateral position and member fractured in dependent position.

Results:

Sensitive block and analgesia was effective during the procedure. Patient did maintain cardiovascular stability, showing minor changes in blood pressure and heart rate during surgery.

Conclusions:

The subarachnoid block with low doses of local anaesthetic could be considered an anaesthetic option for an urgent femoral surgery in a patient with severe AS.

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