Use of noninvasive positive pressure ventilation and spinal anesthesia during hip replacement arthroplasty in a patient with severe chronic obstructive pulmonary disease: case report.

Anesthetic management of patients with severe chronic obstructive pulmonary disease is extensively discussed, due to the high rates of complications in this subtype of patients submitted to medium and high complexity surgical procedures. The objective of this study is to report use of noninvasive positive pressure mechanical ventilation - bilevel positive airway pressure - and spinal anesthesia in a patient with severe chronic obstructive pulmonary disease during total hip arthroplasty. An 81 year old, male patient with severe chronic obstructive pulmonary disease (GOLD 4) was submitted to total hip arthroplasty due to a femoral bone fracture under spinal anestesia and noninvasive positive pressure mechanical ventilation-bilevel positive airway pressure with expiratory pressure of 7 cmH2O, inspiratory pressure of 15 cmH2O and O2 flow of 3 L/min. During the procedure, the patient had one episode of bronchospasm that was promptly reverted pharmacologically with no complications in the postoperative period. The combination of less invasive anesthetic and ventilation techniques is easy to apply and may be useful in the perioperative management of patients with high anesthetic morbidity. Interaction between clinical, surgical and anesthetic teams for these cases is very important to reduce the mortality associated with extensive procedures in severe patients.