Background and Aims Severe aortic stenosis (AS) carries high risk of perioperative mortality. (1) However there is no universal acceptance of spinal anaesthesia in severe aortic stenosis, unilateral spinal anaesthesia (USA) may be safe alternative in these patients. (2)

Methods 93 year old female patient who admitted for emergent above knee amputation. The patien had sclerotic aortic valve with severe aortic stenosis, suffered from hypertension, DM type II, and previous cerebrovascular stroke (CVS) with residual right side weakness and dysarthria. She had pacemaker as a treatment for complete heart block. We anaesthetized her using unilateral spinal anaesthesia (USA).

Results Severe AS is a known risk factor for perioperative mortality. (1) Haemodynamic goals for treating patients with AS include maintaining myocardial oxygen supply via adequate perfusion pressure and diastolic time, preservation of contractility, and maintaining sinus rhythm.(2) There are no evidence based recommendations for the preferred anesthetic regimen in patients with AS. (1) Either general or neuraxial anaesthesia may cause deleterious effects on patients‘ haemodynamics so it is all about the conduct of anaesthesia rather than the specific technique. (2) In comparison to conventional spinal anaesthesia, unilateral spinal anaesthesia provides more haemodynamic stability making it a suitable choice for high risk patients. (3) Guay et al in their meta-analysis concluded that neuraxial anesthesia may reduce the mortality for patients undergoing a surgery with an intermediate-to-high cardiac risk in comparison to general anaesthesia. (4)

Conclusions Large studies are needed to evaluate the role and limitations of central neuraxial anaesthesia in high risk patients.