{"id":"bc64b4bc-6254-4731-8a2f-77f4e670742d","slug":"a-rare-case-of-delayed-subarachnoid-anesthetic-blockade-effects-in-a-103-year-old-female-patient","title":"A rare case of delayed subarachnoid anesthetic blockade effects in a 103-year-old female patient","authors":["Ramsis F. Ghaly","Utchariya Anantamongkol","Kenneth D. Candido","Nebojsa Nick Knezevic"],"abstract":"Background: The elderly represent a unique challenge for the effects of regional anesthesia, and very few cases of block onset delay have been described. Their delayed response is attributed to a number of factors that include: Physiologic deterioration, musculoskeletal contractures, degenerative joint disease, autonomic regulatory dysfunction, cognitive dysfunction, altered pharmacokinetics, and pharmacodynamics of local anesthetics and adjuvants. Case Description: In this report we present the rare case of 45-min delay between the administration and onset of action of a subarachnoid blockade in a 103-year-old female, who was scheduled for left hip pinning, for repair of a femoral neck fracture. Patient received an injection of hyperbaric bupivacaine, 1.5 ml of 0.75% (11.25 mg), with 15 mcg of fentanyl into the subarachnoidal space and underwent the surgical procedure without complications. Conclusions: Delayed responses to subarachnoid anesthesia can be expected in extremely elderly patients. Anesthetic procedures should be monitored and managed on a case-by-case basis.","thumbnailUrl":null,"publishDate":"2015-05-26T00:00:00.000Z","doi":"10.4103/2152-7806.157658","categories":["Case Report"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2015/05/5993/SNI-6-88.pdf"}