Prophylactic Norepinephrine for Spinal Anesthesia in anElderly Patient with Aortic Stenosis.

Abstract

A 76-year-old woman with a left femur neck fracture was admitted for urgent hip bipolar hemiarthroplasty. The patient was prescribed angiotensin-converting-enzyme inhibitor, beta blocker and clopidogrel daily for hypertension and angina. The preoperative echocardiogram showed left ventricular hypertrophy and a severely calcified and thickened aortic valve with stenosis. A single-shot spinal anesthesia was planned. After dural puncture, 9 mg of 0.5 % hyperbaric bupivacaine plus fentanyl 12.5 mcg were injected. At the same time, we started infusion of norepinephrine (50 ng/kg/min) to prevent expected perioperative hypotension. Invasive blood pressure declined during the initial 5 min after intrathecal injection, but recovered quickly. Vital signs were hemodynamically stable and the patient did not need any treatment for surgery. The norepinephrine infusion was safely tapered down over 15 min while skin incision was closed. We found that prophylactic short-term norepinephrine infusion can be safely used for expected hypotension induced by a single-shot spinal block in an elderly patient with aortic stenosis.