ESRA Academy. Silva E. Sep 8, 2016; 138570; 0444 Topic: Safety of Regional Anaesthesia - Complications - General Aspects
Eva Silva
Eva Silva

Access to Premium content is currently a membership benefit.

Click here to join ESRA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

Elderly patients with its multiple comorbidities are at higher risk of developing complications related to genral anesthesia.
General anaesthesia carries high risks of postoperative pulmonary complications with increased morbidity and mortality in patients with severe respiratory disease. Anesthesia regional is a safe option for this patients because: first, they are minimally sedated; second, they breathe spontaneously;  and third, they have an excellent postoperative pain control.
The authors describe a case report, describing the anesthetic management and special precautions in a patient with pulmonary fibrosis for an emergency surgery.


Female, 77 years old, ASA physical score III, with history of pulmonary fibrosis and arterial hypertension. METs < 4. She was proposed for emergency dynamic hip screw fixation for intertrochanteric fracture and open reduction and internal fixation of proximal humerus fracture. The patient had no previous anesthaetic history.
Midazolam 1mg ev and regional anesthesia with interscalene brachial plexus block in dorsal decubitus  (75mg mepivacaine 1.5% and 50mg ropivacaine 0.5%) were administred using ecographic assistance. Following patient positioning in lateral decubitus, L4-L5 subarachnoid block (10mg levobupicaine 0.5%) was made. An adequate intravenous fluid initially with Ringer's Lactate solution was initiated  as the block was developing and maintained with sodium chloride 0.9% solution during the block.


No perioperative complication occurred.


In this case, the regional anesthesia, the assistance of ecography (due to its several advantages when compared with neurostimulator) and the adequate preload were the main precautions, to ensure a safe procedure in an elderly patient with a severe respiratory disease, during all the perioperative period.

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings