Continuous spinal anesthesia for hip replacement in an elderly

Bol Asoc Med P R · Apr 2012

Case Reports

Continuous spinal anesthesia for hip replacement in an elderly patient with an anterior mediastinal mass: a case report.

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.

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- Victor Rivero, Osmar Creagh, Daniel Fernández, César Hernández, and Alberto Rivera.
- Department of Anesthesiology, UPR School of Medicine, Puerto Rico Medical Sciences Campus, San Juan, PR 00926. vrivero@hotmail.com
- Bol Asoc Med P R. 2012 Apr 1;104(2):80-1.
AbstractIncremental 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.

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Continuous spinal anesthesia for hip replacement in an elderly patient with an anterior mediastinal mass: a case report.

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