Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis

María Mercedes López; Emilia Guasch; Renato Schiraldi; Genaro Maggi; Eduardo Alonso; Fernando Gilsanz

doi:10.1016/j.bjane.2013.03.010

Clinical Information

Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis

Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva para cirurgia de reparação do quadril em dois pacientes com estenose aórtica grave

María Mercedes López; Emilia Guasch; Renato Schiraldi; Genaro Maggi; Eduardo Alonso; Fernando Gilsanz

http://dx.doi.org/10.1016/j.bjane.2013.03.010 Braz J Anesthesiol, vol.66, n1, p.82-85, 2016

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Abstract

BACKGROUND AND OBJECTIVES: Aortic stenosis increases perioperative morbidity and mortality, perioperative invasive monitoring is advised for patients with an aortic valve area <1.0 cm2 or a mean aortic valve gradient >30 mm Hg 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. CASE REPORT: 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 2 mg 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. CONCLUSION: 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.

Keywords

Anaesthetic techniques - subdural, Measurement techniques - cardiac output

Resumo

JUSTIFICATIVA E OBJETIVOS: A estenose aórtica aumenta a morbidade e mortalidade no período perioperatório. A monitoração invasiva no perioperatório é recomendada para pacientes com área valvar <1,0 cm2 ou gradiente médio >30 mm Hg, além de ser importante evitar a hipotensão e arritmias. Relatamos o manejo anestésico com o uso de raquianestesia contínua e monitoração hemodinâmica minimamente invasiva em duas pacientes com estenose aórtica grave, submetidas à cirurgia de reparação do quadril. RELATO DE CASO: Duas pacientes com estenose aórtica grave foram programadas para cirurgia de reparação de fratura de quadril. Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva foi usada para o manejo anestésico de ambas as pacientes. A cirurgia foi realizada com sucesso após duas doses consecutivas de 2 mg de bupivacaína isobárica a 0,5% em uma das pacientes e quatro doses consecutivas na outra. As condições hemodinâmicas permaneceram estáveis durante a intervenção. Os sinais vitais e parâmetros hemodinâmicos permaneceram estáveis durante as duas intervenções. CONCLUSÃO: Nosso relato descreve o uso da raquianestesia contínua com monitoração hemodinâmica minimamente invasiva como uma alternativa válida para a anestesia geral ou peridural em duas pacientes com estenose aórtica grave, submetidas à cirurgia de membro inferior. Contudo, ensaios clínicos controlados são necessários para estabelecer que a técnica é segura e eficaz nesse tipo de pacientes.

Palavras-chave

Técnicas anestésicas, subdural, Técnicas de mensuração, débito cardíaco

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Continuous spinal anaesthesia with minimally invasive haemodynamic monitoring for surgical hip repair in two patients with severe aortic stenosis

Raquianestesia contínua com monitoração hemodinâmica minimamente invasiva para cirurgia de reparação do quadril em dois pacientes com estenose aórtica grave

María Mercedes López; Emilia Guasch; Renato Schiraldi; Genaro Maggi; Eduardo Alonso; Fernando Gilsanz

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