Background and Aims Anesthetic management of patients with pulmonary hypertension (PH) is complex and carries a high potential of perioperative morbidity and mortality.

Methods We report a continuous spinal anesthesia (CSA) for retropubic prostatectomy.

Results A 71-year-old man, ASA IV with a very severe COPD conditioning severe PH was proposed for retropubic prostatectomy. Because of the risks of general anesthesia (GA) in this patient, we decided to perform a CSA with the IntraLong kit from PAJUNK. In lateral position under full aseptic precaution, a 21G pencil point needle was inserted into the L3-L4 space. After obtaining free flow of cerebrospinal fluid, a 25G catheter was introduced. We started with 5 mg of levobupivacaine. With a light slope the dose was titrated (2,5 mg at the time) until adequate block was achieved. During surgery, the patient was always hemodynamically stable and we used a total of 15 mg of levobupivacaine.

At the end of the surgery the catheter was withdrawn, and postoperative recovery was uneventful.

Conclusions The anesthetic management of a patient with PH is a challenge. GA with positive pressure ventilation in associated with a potential risk of cardiorespiratory decompensation. However, spinal anesthesia is associated with a risk of severe hypotension which can be catastrophic in a patient with low functional capacity. With the use of CSA we can titrate the local anesthetic to maintain hemodynamic stability in the perioperative period with no vasopressors needed and with spontaneous ventilation with a peripheral saturation >92%.