[Continuous spinal anesthesia for femoral fracture in two patients with severe aortic stenosis].
Neuraxial blockade is usually not recommended in patients with aortic stenosis. However, neuroaxial blockade techniques such as continuous spinal or epidural anaesthesia can be tailored to minimize potentially dramatic consequences of decrease in systemic vascular resistance, often encountered after standard single shot spinal anaesthesia. We report the cases of two severe aortic stenosis patients (aortic valve area<0.5 cm2) that underwent hip surgery under continuous spinal anaesthesia. Small doses of isobaric 0.25% bupivacaine titrated to limit total dose below 5 mg, injected through the intrathecal catheter allowed the control of haemodynamic parameters. No clinical complication occurred in these two patients.
Fuzier
R
R
Service Orthopédie et Traumatologie, Département d'Anesthésie, CHU de Purpan, place du docteur-Baylac, TSA 40031, 31059 Toulouse cedex 09, France. fuzier.r@chu-toulouse.fr
Murat
O
O
Gilbert
M-L
ML
Maguès
J-P
JP
Fourcade
O
O
D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000379:methods*; D001024:Aortic Valve Stenosis / Q000150:complications*; D019644:Arthroplasty, Replacement, Hip; D001858:Bone Nails; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use; D000075202:Contraindications; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005265:Femoral Neck Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006439:Hemodynamics; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications; D018497:Ventricular Dysfunction, Right / Q000150:complications
D002045:Bupivacaine