70 Abdominal surgery in high-risk cardiovascular patient – anesthetic option

Background and Aims Continuous spinal (CSA) comparing to spinal anesthesia offers advantages in patients with multiple comorbilities. Fractionation of doses allows to obtain a satisfactory sensory and motor block with lower total doses of local anesthetic and less hemodynamic collapse. Methods 89-year-old female, ASA IV admitted for emergency hernioplasty due to strangulated umbilical hernia. She had Hypertension, Diabetes Mellitus, obesity, OSAS, stage IV CKD and heart failure. She was polypneic, tachycardic and hypotensive. The airway assessment was poorly done due to the patient‘s lack of collaboration. Given the severity of the patient‘s clinical situation, the surgical proposal, as well as the absence of criteria for admission to the ICU, we opted for CSA. Caregiver’s consent to anesthesia was obtained. A Tuhoy 18G needle was used in the L3-L4 space and the catheter was inserted 4cm into the subarachnoid space. 2.5 mg of 0.5% hyperbaric bupivacaine were administered through catheter, followed by 1 mL of saline. 5’ and 10’ after the first administration, 1.25 mg + 1.25 mg bupivacaine were administered, respectively. A satisfactory block at T7-T8 level was obtained. The surgery lasted 2.5 hours. At the end of the first and second hour after surgical incision, reinforcement was needed with 2.5 mg of 0.5% bupivacaine. Results The patient remained hemodynamically stable and conscious. She was discharged from the hospital with no record of complications. Conclusions The number of high-risk frail patients is increasing. CSA allows the anesthetist to better manage these patients due to the fractionation of doses and greater control over the hemodynamic repercussions.