{
  "abstract": "Application for ESRA Abstract Prizes:Background and Aims Continuous spinal anesthesia (CSA) offers an alternative to single-shot spinal anesthesia in frail, elderly patients undergoing prolonged lower extremity surgery. Its ability to fractionate intrathecal local anesthetic dosing allows for a gradual onset of sympathetic blockade, mitigating hemodynamic instability compared to single-dose techniques. Point-of-care ultrasound (POCUS) is an effective tool for perioperative assessment in high-risk patients.Methods Case 1:An 84-year-old ASA III male with ischemic heart disease, atrial fibrillation, and pulmonary hypertension was scheduled for femoral nail replacement. Preoperative POCUS revealed severe pulmonary hypertension, an atrial septal defect, and venous congestion (VExUS grade 2). CSA was performed using a 20G catheter with incremental dosing of hyperbaric bupivacaine (total 12.5 mg). Hemodynamics remained stable without vasopressors. Postoperatively, the patient developed transient atrial tachyarrhythmia managed with volume replacement and antiarrhythmics. Case 2: An 80-year-old ASA IV female with COPD, heart failure, and chronic prosthetic joint infection underwent knee prosthesis explantation. Baseline POCUS showed chronic cor pulmonale, moderate biventricular dysfunction, and VExUS grade 1. CSA with isobaric bupivacaine (total 10 mg) and sedation was used, supported by high-flow nasal cannula. Intraoperative course was stable, recovery uneventful.Results CSA enables controlled LA administration with minimal hemodynamic impact in high-risk patients. The incidence of post-dural puncture headache with microcatheters is 1.0–6.5% and infection and hematoma is similar to other neuroaxial techniques. POCUS aids in identifying cardiovascular compromise and guiding management. Its integration enhances perioperative safety.Conclusions CSA, in combination with POCUS, is a safe and effective technique in high-risk geriatric patients undergoing prolonged lower limb surgery.",
  "authors": [
    {
      "affiliations": [
        "Servei d’Anestesiologia, Reanimació i Terapèutica del Dolor , Hospital Universitari Mútua de Terrassa, Terrassa, Spain"
      ],
      "name": "Iris Jürgens Sanchez"
    },
    {
      "affiliations": [
        "Servei d’Anestesiologia, Reanimació i Terapèutica del Dolor , Hospital Universitari Mútua de Terrassa, Terrassa, Spain"
      ],
      "name": "Hector Villanueva Sanchez"
    },
    {
      "affiliations": [
        "Servei d’Anestesiologia, Reanimació i Terapèutica del Dolor , Hospital Universitari Mútua de Terrassa, Terrassa, Spain"
      ],
      "name": "Enrique Márquez Sánchez"
    },
    {
      "affiliations": [
        "Servei d’Anestesiologia, Reanimació i Terapèutica del Dolor , Hospital Universitari Mútua de Terrassa, Terrassa, Spain"
      ],
      "name": "Xavier Balderas González"
    },
    {
      "affiliations": [
        "Servei d’Anestesiologia, Reanimació i Terapèutica del Dolor , Hospital Universitari Mútua de Terrassa, Terrassa, Spain"
      ],
      "name": "Olga Gómez Ortiz"
    },
    {
      "affiliations": [
        "Servei d’Anestesiologia, Reanimació i Terapèutica del Dolor , Hospital Universitari Mútua de Terrassa, Terrassa, Spain"
      ],
      "name": "Margarita Novellas Canosa"
    }
  ],
  "title": "P265 Continuous spinal anesthesia in high-risk geriatric patients: a report of two clinical cases and review of perioperative point-of-care ultrasound utility",
  "uid": "890fed48-3047-5eb6-b21e-04ee61aaabac"
}