title: Anesthetic management for lower limb fracture in severe aortic valve stenosis and fat embolism: a case report and review of literature.
abstract: BACKGROUND
  Anesthesia in severe aortic stenosis, which describes a valve surface area less than 1 cm(2), can result in rapid clinical deterioration and patient mortality. These patients may require treatment for aortic stenosis before any surgical intervention. In suitable patients percutaneous balloon aortic valvutomy appears to carry lower risk, but in emergency situations, it is important to determine which kind of anesthesia technique has the lowest risk for these patients, without any cardiac intervention.
  
  
  METHODS
  In this case report, we present a patient who had tibia and fibula fractures and a symptomatic severe critical aortic stenosis which was diagnosed during a preoperative visit. The patient had exertional dyspnea, palpitations and fainting history, but he had not received any medical therapy before the present admission. During hospitalization and preoperative evaluation, a fat embolism occurred and the patient was admitted to the intensive care unit. Immediately after his recovery, we successfully managed the tibia and fibula fracture fixation without any cardiac intervention.
  
  
  CONCLUSIONS
  Our anesthesia method was sciatic and femoral nerve block under double ultrasonic and nerve stimulator guidance.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Faranak
authors.initials: F
authors.lastname: Rokhtabnak
authors.affiliation: Department of Anesthesiology and Pain Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Mahdi
authors.initials: MM
authors.lastname: Zamani
authors.affiliation: Department of Anesthesiology and Pain Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Kholdebarin
authors.affiliation: Department of Anesthesiology and Pain Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Pournajafian
authors.affiliation: Department of Anesthesiology and Pain Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Ghodraty
keywords: Aortic Valve Stenosis; Fat Embolism; Femoral Nerve; Sciatic Nerve