title: A rare case of delayed subarachnoid anesthetic blockade effects in a 103-year-old female patient.
abstract: BACKGROUND
  The elderly represent a unique challenge for the effects of regional anesthesia, and very few cases of block onset delay have been described. Their delayed response is attributed to a number of factors that include: Physiologic deterioration, musculoskeletal contractures, degenerative joint disease, autonomic regulatory dysfunction, cognitive dysfunction, altered pharmacokinetics, and pharmacodynamics of local anesthetics and adjuvants.
  
  
  METHODS
  In this report we present the rare case of 45-min delay between the administration and onset of action of a subarachnoid blockade in a 103-year-old female, who was scheduled for left hip pinning, for repair of a femoral neck fracture. Patient received an injection of hyperbaric bupivacaine, 1.5 ml of 0.75% (11.25 mg), with 15 mcg of fentanyl into the subarachnoidal space and underwent the surgical procedure without complications.
  
  
  CONCLUSIONS
  Delayed responses to subarachnoid anesthesia can be expected in extremely elderly patients. Anesthetic procedures should be monitored and managed on a case-by-case basis.
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 ; Department of Anesthesiology, JHS Hospital of Cook County, Chicago, IL 60612 ; Ghaly Neurosurgical Associates, Aurora, IL 60504 ; Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.
authors.forename: Ramsis F
authors.initials: RF
authors.lastname: Ghaly
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657.
authors.forename: Utchariya
authors.initials: U
authors.lastname: Anantamongkol
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 ; Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Candido
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657 ; Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA.
authors.forename: Nebojsa Nick
authors.initials: NN
authors.lastname: Knezevic
keywords: Delayed response; elderly patients; subarachnoid anesthetic blockade