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Background and Aims When the risks of approaching a difficult airway are high, regional anesthesia often becomes a wiser option. In order to avoid general anesthesia it becomes necessary to implement strategies that maximize the effectiveness of regional techniques, including optimizing patient cooperation and favoring regional techniques whose duration can be extended to meet the needs of prolonged surgery.
Methods Patient: 88-year-old female, with diabetes, hypertension, degenerative osteoarticular disease, dementia, and previous maxillectomy with ATM arthrodesis. Procedure: Hip arthroplasty due to hip frature Anesthetic plan: A dexmedetomidine infusion was started 2 hours before coming to the operating room and was maintained throughout the procedure (0,1-0,4mcg/kg/h). A continuous spinal catheter (25G) was placed in L3/4, through an intrathecal Sprout needle (21G) – IntraLong (r) 21G/25G PAJUNK. An initial bolus of 2.5mg levobupivacaine 0,5% + 2.5mcg sufentanil was administered. The procedure lasted 2 hours and an additional dose of 1mg levobupivacaine 0,1% was given. The catheter was removed at the end of the procedure.
Results The patient remained in RASS -2, on spontaneous ventilation, without the need for additional oxygen supply and was hemodynamically stable throughout the procedure. The postoperative course was uneventful.
Conclusions In this case, avoiding the airway was highly desirable, but delirium could compromise patient cooperation during regional anesthesia. Sedation was necessary and dexmedetomidine was chosen because of its beneficial effect on delirium and respiratory stability. Continuous spinal anesthesia was chosen for its effectiveness in surgical anesthesia and due to the unpredictability of the duration of the procedure.
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