{
  "abstract": "Background and Aims Deciding on the type of anesthesia in patients with pulmonary hypertension (PH) undergoing noncardiac surgery is not easy. It is burdened with fatal outcome.Methods A 84-year-old female patient (165 cm, 80 kg) was scheduled for femoral shaft osteosynthesis. Previously, she had a transcatheter aortic valve implanted and was diagnosed with pre- and post-capillary PH. Twelve days before the surgery she suffered anterior myocardial infarction that resulted in implantation of a drug eluting stent and consequential dual anti-aggregation therapy. Nevertheless, she was highly motivated for the operation even though she was informed of the risks with her being an American Society of Anesthesiologists (ASA) score IV patient. Premedication consisted of excluding clopidogrel for 6 days, with acetylsalicylic acid remaining and given to her together with enoxaparine on the day before surgery. With sildenafil three times a day being part of her daily routine, she took a 20 mg tablet on the morning of surgery. An ultrasound guided fascia iliaca block (FIB) was performed (30 ml 0.25% levobupivacaine). After thirty minutes spinal anaesthesia (SA) at L3 - L4 interspace (6.66 mg of 0.5% isobaric levobupivacaine and 33.3 mcg fentanyl) was administered. Patient was sedated using esketamin and fentanyl, with oxygen given via nasal catheter. Multimodal analgesia with paracetamol and ketoprofen was instituted in the operating room.Results The patient was hemodynamically stable throughout the surgery as well as later, in surgical intensive care unit. Two hours after the procedure she was able to move both of her legs, with operated leg being slightly numb. She did not report any pain. Due to drop in hemoglobin 2 units of erythrocyte concentrates were administered. The rest of hospitalization was unremarkable and she was discharged on the seventh postoperative day.Abstract P005 Figure 1Operating room setupAbstract P005 Figure 2Diaphyseal femur fractureConclusions SA together with FIB proved as an excellent option for our patient with PH.",
  "authors": [
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Medicine, University Hospital of Split, Split, Croatia"
      ],
      "name": "Anamarija Mimica"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Medicine, University Hospital of Split, Split, Croatia"
      ],
      "name": "Anamarija Mimica"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Medicine, University Hospital of Split, Split, Croatia"
      ],
      "name": "Ana Šarić Jadrijev"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Hospital of Split, Split, Croatia"
      ],
      "name": "Mislav Lozo"
    },
    {
      "affiliations": [
        "Department of Surgery, University Hospital of Split, Split, Croatia"
      ],
      "name": "Josip Knežević"
    },
    {
      "affiliations": [
        "Department of Surgery, University Hospital of Split, Split, Croatia"
      ],
      "name": "Josip Bekavac"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Medicine, University Hospital of Split, Split, Croatia"
      ],
      "name": "Nikola Delić"
    },
    {
      "affiliations": [
        "Department of Anaesthesiology and Intensive Medicine, University Hospital of Split, Split, Croatia"
      ],
      "name": "Toni Kljaković-Gašpić"
    }
  ],
  "title": "P005 Regional anaesthesia in a surgical patient with severe pulmonary hypertension: a case report",
  "uid": "0c209019-4e84-503e-b416-5b9b5de1334b"
}