Challenges and Success: General Anaesthesia for Re-Do Spine Surgery in an Elderly Woman With Sepsis, Pulmonary Hypertension, and Hemodynamic Instability on Positioning for Surgery: A Case Report

Abstract

Geriatric patients exhibit reduced physiological reserve due to age-related organ system changes, predisposing them to increased perioperative morbidity and mortality, particularly in the presence of multiple comorbidities and sepsis. Objective: To highlight perioperative anaesthetic challenges and management strategies in a high-risk geriatric patient with complex comorbidities undergoing surgery. Methods: This case report describes a 95-year-old female with hypothyroidism, rheumatoid arthritis, valvular heart disease, and pulmonary hypertension who developed myocardial infarction, urinary tract infection, and surgical site infection following microendoscopic spine surgery. She was planned for wound debridement after comprehensive preoperative optimisation. Detailed cardiovascular evaluation was performed, and invasive hemodynamic monitoring was instituted. Intraoperative anaesthetic management focused on maintaining hemodynamic stability, avoiding factors that increase pulmonary vascular resistance, and ensuring vigilant monitoring throughout the perioperative period. Results: During surgery, the patient developed complete heart block while positioned prone, necessitating immediate application of transcutaneous pacing pads and modification of surgical positioning. Prompt recognition and intervention prevented further hemodynamic deterioration. The procedure was completed safely under close monitoring without progression to cardiac arrest or severe instability. Conclusion: Careful preoperative optimisation, invasive monitoring, and prompt intraoperative decision making are crucial in elderly patients with severe comorbidities. Individualised anaesthetic planning and avoidance of precipitating factors for pulmonary vasoconstriction can significantly improve perioperative outcomes in this vulnerable population.