Effective anesthetic management using continuous spinal anesthesia in a high-risk patient: A case report

Continuous spinal anesthesia (CSA) is an underutilized anesthetic technique, particularly in high-risk patients with significant comorbidities. This case report highlights the novel application of CSA to manage a patient with severe hemodynamic instability undergoing total hip arthroplasty for management of a femoroacetabular impingement, demonstrating its safety and efficacy as an alternative to general anesthesia. A male patient in his early 60s, classified as ASA 4, presented with a BMI of 34.82 kg/m 2 and a history of cerebrovascular accident, obstructive sleep apnea, and severe cardiovascular disease. The patient required surgery but was deemed at high risk for general anesthesia due to hemodynamic instability. CSA was selected to minimize systemic medication dosages and avoid airway manipulation while maintaining stable vital signs. Isobaric bupivacaine was administered to achieve the desired anesthetic effect. The procedure was successful, with no notable anesthesia events or complications, and the patient's postoperative course was uneventful, and he remained stable through discharge. This case underscores the potential of CSA as a safe and effective alternative to general anesthesia in high-risk surgical patients. Its benefits include stable hemodynamics, reduced systemic drug exposure, and avoidance of airway manipulation. Further research into the application of CSA in critically ill patients is warranted to expand its use in anesthetic practice.