title: Continuous spinal anesthesia for hip replacement in an elderly patient with an anterior mediastinal mass: a case report.
abstract: Incremental dosing of intrathecal local anesthetic for an indefinite duration performed during continuous spinal anesthesia (CSA) allows for better control of adverse effects caused by sympathetic nerve blockade. This case report describes a 91-year-old female with a left intertrochanteric fracture and a large thyroid mass causing contralateral anterior displacement of the trachea and the great vessels. We conducted a detailed investigation of the different techniques that can be used in such circumstances and the consequences each may have on a patient. We concluded that: better control of sympathetic nerve blockade and less adverse effects can be achieved with CSA, optimal management of thrombocytopenia should be done in a patient prior to regional anesthesia, and CSA is an anesthetic alternative to consider on elderly patients with an anterior mediastinal mass undergoing hip fracture surgery.
authors.affiliation: Department of Anesthesiology, UPR School of Medicine, Puerto Rico Medical Sciences Campus, San Juan, PR 00926. vrivero@hotmail.com
authors.forename: Victor
authors.initials: V
authors.lastname: Rivero
authors.forename: Osmar
authors.initials: O
authors.lastname: Creagh
authors.forename: Daniel
authors.initials: D
authors.lastname: Fernández
authors.forename: César
authors.initials: C
authors.lastname: Hernández
authors.forename: Alberto
authors.initials: A
authors.lastname: Rivera
mesh_terms: D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008482:Mediastinum; D013964:Thyroid Neoplasms / Q000150:complications* / Q000473:pathology