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Background and Aims Sheehan syndrome (SS) is a form of hypopituitarism caused by pituitary gland infarction after severe postpartum hemorrhage (PPH), leading to variable degrees of pituitary hormone deficiency. Main anaesthetic concerns include electrolyte imbalance, hypocortisolism, hypothyroidism, hypotension, hypothermia and reduced drug metabolism. Regional anesthesia techniques are usually beneficial in these patients in order to reduce hormonal stress response.

Methods An 80-year-old female patient, ASA III, was proposed for reduction and osteosynthesis of a pelvic fracture. The patient had a diagnosis of SS based on past history of severe PPH with subsequent lactation failure and an empty sella turcica, associated with adrenal insufficiency, hypothyroidism and hyponatremia. Other known diagnosis included dyslipidemia. Due to ventral decubitus positioning, duration and extent of surgery, general anaesthesia is usually indicated in major pelvic surgery and because a posterior surgical approach was elected, use of an epidural catheter wasn´t recommended. We opted for total intravenous anesthesia associated with a subarachnoid block to reduce metabolic stress response to surgery and minimize intravenous opioid use.

Results Perioperative management included early admission for preoperative hyponatremia correction with hypertonic saline, glucocorticoid supplementation with intraoperative hydrocortisone 100mg intravenous bolus followed by 50mg every 8h postoperative. Before anaesthesia induction a subarachnoid block was performed in the L4-L5 interspace with 2ml of 0,25% levobupivacaine and 100mcg morphine. The procedure and recovery were successful and uneventful.

Conclusions Adequate preoperative optimization is key in SS patients and the anaesthetic approach should be tailored to the patients’ needs and surgical requirements, profiting from the synergistic interaction between general and regional anesthesia.