{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:28:25Z","timestamp":1787228905704,"version":"build-2736575974"},"reference-count":7,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    We present the case of a 78-year-old man (ASA III), with chronic ischemic heart disease, moderate aortic stenosis, hypertension, diabetes, and renal failure undergoing a second revision hip arthroplasty. Continuous spinal anesthesia (CSA) was performed using an ultra-low dose of 6.25 mg 0.25% isobaric levobupivacaine (3.75 mg + 2.5 mg) without adjuvants, preserving the possibility of incremental dosing if necessary. Intraoperative monitoring documented exceptional hemodynamic stability throughout the entire procedure (180 min), with mean arterial pressure maintained between 75 and 84 mmHg and heart rate between 63 and 70 bpm, without requiring vasopressors. The sensory block (T10) and motor block (Bromage 3) were adequate and regressed to Bromage 0 by the end of the procedure. The patient remained spontaneously breathing room air with an SpO\n                    <jats:sub>2<\/jats:sub>\n                    &gt;98%. The presented case demonstrates that ultra-low dose CSA may represent a valuable option for reducing the perioperative risk in carefully selected high-risk orthogeriatric patients.\n                  <\/jats:p>","DOI":"10.4103\/sja.sja_864_25","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:00:06Z","timestamp":1782968406000},"page":"698-701","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Ultra-low dose continuous spinal anesthesia for major orthogeriatric surgery in a high cardiovascular risk patient on chronic aspirin therapy: A case report"],"prefix":"10.4103","volume":"20","author":[{"given":"Francesco","family":"Tasso","sequence":"first","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Cialdella","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Loppini","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Monteleone","sequence":"additional","affiliation":[{"name":"IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"R1-20260820","doi-asserted-by":"crossref","first-page":"411","DOI":"10.56238\/isevjhv3n2-004","article-title":"Management of anesthesia in elderly patients, special considerations and challenges","volume":"3","author":"Souza","year":"2024","journal-title":"Int Seven J Health 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patients","volume":"77","author":"Klimscha","year":"1993","journal-title":"Anesth Analg"},{"key":"R5-20260820","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1097\/AAP.0b013e318252e901","article-title":"Hemodynamic profile of target-controlled spinal anesthesia compared with 2 target-controlled general anesthesia techniques in elderly patients with cardiac comorbidities","volume":"37","author":"Biboulet","year":"2012","journal-title":"Reg Anesth Pain Med"},{"key":"R6-20260820","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s12871-019-0682-1","article-title":"Effects of bupivacaine or levobupivacaine on cerebral oxygenation during spinal anesthesia in elderly patients undergoing orthopedic surgery for hip fracture: a randomized controlled trial","volume":"19","author":"Vives","year":"2019","journal-title":"BMC Anesthesiol"},{"key":"R7-20260820","doi-asserted-by":"crossref","first-page":"e0306591","DOI":"10.1371\/journal.pone.0306591","article-title":"Differences in sensory nerve block between levobupivacaine and bupivacaine at low concentrations in humans and animals","volume":"20","author":"Sakamoto","year":"2025","journal-title":"PLoS One"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_864_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:01:26Z","timestamp":1787227286000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_864_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":7,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_864_25","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-10-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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