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Background and Aims Aortic stenosis (AS) is a cause of mortality or morbidity. It complicates the selection and management of anesthetic procedures. The aim of this study was to evaluate the efficacy, hemodynamic effects and postoperative outcome of unilateral spinal anesthesia (USA) in geriatric hip fractured patients with moderate or severe AS.

Methods A retrospective observational study was conducted on geriatric highrisk patients with cardiac conditions who underwent surgery for hip fractures under unilateral spinal anesthesia with low-dose hyperbaric bupivacaine (6,5-7,5 mg). The study period spanned from January 2018 to December 2021. The inclusion criteria were individuals with moderate to severe aortic stenosis, as defined by the American Heart Association Criteria. Data on demographic information, cardiac pathologies, hemodynamic data, motor and sensory block levels, perioperative complications, and mortality rates within the first month and between the 30th and 180th days were collected.

Results Mortality rates at the 30th day and 180th day were 8.9% (n:4) and 24,4% (n:11), respectively. T6 level was predominantly observed (44.4%). Motor and sensory block formation times averaged 7.56 and 4.84 minutes, respectively. Surgical procedures were performed mostly within 1 hour (66.7%), and complications were rare (11.1% hypotension). Initial analgesic effect showed a rapid resolution, with 64.4% of patients requiring analgesic within the first hour postoperatively.

Conclusions In elderly patients with moderate to severe aortic stenosis scheduled for noncardiac surgical procedures, undergoing preoperative multidisciplinary optimization, we posit that unilateral spinal anesthesia with ultra-low doses represents a safe and effective option.