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Critical aortic stenosis for urgent surgery — FRCA Final MCQ

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HardCardiothoracic and Vascular AnaesthesiaCritical aortic stenosis for urgent surgeryFRCA Final

A 78-year-old man with critical aortic stenosis presents for urgent hip hemiarthroplasty. Echocardiography shows valve area 0.6 cm2 and preserved left ventricular function. He is in sinus rhythm, blood pressure 145/80 mmHg, and has exertional syncope. What is the most appropriate anaesthetic technique?

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Correct answer: E — Carefully titrated general anaesthesia with invasive arterial pressure monitoring

Critical aortic stenosis requires maintenance of sinus rhythm, preload and systemic vascular resistance, with beat-to-beat blood pressure monitoring for urgent surgery. A high-dose spinal may cause abrupt sympathectomy and cardiovascular collapse. Deliberate vasodilation or hypotension is hazardous. The anaesthetic can be general or carefully titrated neuraxial in selected contexts, but sudden haemodynamic shifts must be avoided.

Reference: Association of Anaesthetists peri-operative blood pressure guideline 2026; ESC valvular disease guidance