Selective Spinal Anesthesia in a Patient with Low Ejection Fraction Who Underwent Emergent Below-Knee Amputation in a Resource-Constrained Setting

Patients with congestive heart failure have a high risk of perioperative major adverse cardiac events and death. The major perioperative goal of management in patients with low ejection fraction is maintaining hemodynamic stability. Evidence is scarce on the safety of a certain anesthetic technique...

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Bibliographic Details
Published in:Local and regional anesthesia 2020-10, Vol.13, p.135-140
Main Authors: Mulugeta, Hailemariam, Zemedkun, Abebayehu, Getachew, Hailemariam
Format: Article
Language:English
Subjects:
Amputation
Anesthesia
Blood pressure
Bupivacaine
Cardiac patients
Case Report
congestive heart failure: low ejection fraction
Dexmedetomidine
Diabetes
dilated cardiomyopathy
Ejection fraction
Epidural
Fentanyl
Foot diseases
Heart failure
Heart rate
Hypotension
Laboratories
Leg ulcers
Morbidity
Mortality
Nesiritide
neuraxial anesthesia: cardiovascular effects
Patients
spinal anesthesia spread: factors
spinal anesthesia: complications
Surgery
Urine
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Summary:Patients with congestive heart failure have a high risk of perioperative major adverse cardiac events and death. The major perioperative goal of management in patients with low ejection fraction is maintaining hemodynamic stability. Evidence is scarce on the safety of a certain anesthetic technique for patients with heart failure. In this report, we present a 48-year-old man with ischemic dilated cardiomyopathy and low-output congestive heart failure (estimated ejection fraction of 27%) who underwent emergent below-knee amputation under selective spinal anesthesia without any apparent complications. We believe that selective spinal anesthesia can be a useful alternative anesthetic technique in patients with low ejection fraction undergoing emergent lower limb surgery. We showed evidence-based and customized anesthetic management of a high-risk patient with the available equipment and resources. This report will hopefully show the contextual challenges of the perioperative care of critically ill patients in resource-constrained settings. Keywords: congestive heart failure, low ejection fraction, dilated cardiomyopathy, neuraxial anesthesia, cardiovascular effects, spinal anesthesia spread, factors
ISSN:1178-7112
1178-7112
DOI:10.2147/LRA.S277152