title: Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis.
abstract: OBJECTIVE
  Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area <1.0 cm(2) or a mean aortic valve gradient >30 mmHg and it is important to avoid hypotension and arrhythmias. We report the anaesthetic management with continuous spinal anaesthesia and minimally invasive haemodynamic monitoring of two patients with severe aortic stenosis undergoing surgical hip repair.
  
  
  METHODS
  Two women with severe aortic stenosis were scheduled for hip fracture repair. Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring was used for anaesthetic management of both. Surgery was performed successfully after two consecutive doses of 2mg of isobaric bupivacaine 0.5% in one of them and four consecutive doses in the other. Haemodynamic conditions remained stable throughout the intervention. Vital signs and haemodynamic parameters remained stable throughout the two interventions.
  
  
  CONCLUSIONS
  Our report illustrates the use of continuous spinal anaesthesia with minimally invasive haemodynamic monitoring as a valid alternative to general or epidural anaesthesia in two patients with severe aortic stenosis who are undergoing lower limb surgery. However, controlled clinical trials would be required to establish that this technique is safe and effective in these type or patients.
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: María Mercedes
authors.initials: MM
authors.lastname: López
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Emilia
authors.initials: E
authors.lastname: Guasch
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Renato
authors.initials: R
authors.lastname: Schiraldi
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain. Electronic address: genaromaggi@hotmail.com.
authors.forename: Genaro
authors.initials: G
authors.lastname: Maggi
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Alonso
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain; Sociedad Española de Anestesiologia, Reanimacion y Terapeutica del Dolor, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000379:methods*; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000473:pathology; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006439:Hemodynamics; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D012720:Severity of Illness Index
chemical_list: D002045:Bupivacaine
keywords: Anaesthetic techniques – subdural; Measurement techniques – cardiac output; Técnicas anestésicas – subdural; Técnicas de mensuração – débito cardíaco