Continuous Spinal Anesthesia in a High-Risk Patient With Pulmonary Hypertension Undergoing Hip Fracture Repair: A Case Report.

This report describes the successful use of continuous spinal anesthesia (CSA) in a 70-year-old woman with severe pulmonary hypertension (PH), right ventricular (RV) dysfunction, and obstructive sleep apnea (OSA) undergoing hip fracture repair. The perioperative challenge was to manage a patient at high risk of hemodynamic decompensation and severe gas exchange impairment. CSA allowed preservation of spontaneous ventilation and incremental titration of local anesthetic, while hemodynamic stability was maintained with early norepinephrine support. This case illustrates the importance of individualized, pathophysiology-based anesthetic planning in high-risk cardiopulmonary patients.