Neuraxial versus general anesthesia in a patient with asymptomatic severe aortic stenosis

Abstract

A 72-year-old gentleman with asymptomatic severe aortic stenosis (AS) presents for right hip replacement after a fall at home. He was diagnosed with severe AS months before due to a murmur on physical examination, leading to an echocardiogram showing an aortic valve area of 0.9 cm2 with a mean gradient of 40 mm Hg and a left ventricular ejection fraction of 55 %. He is fully functional in his activities of daily living and denies dyspnea on exertion, angina, or syncopal episodes. He has no risk factors for a difficult airway on physical examination. You are asked to devise a safe anesthetic plan for his hip replacement, weighing the risks and benefits of neuraxial versus general anesthesia in light of his cardiac condition.