Abstract
The ejection fraction is calculated by dividing the stroke volume by the end diastolic volume. It is literally the fraction of the end diastolic ventricular volume that is ejected with each beat. This measurement is important to know how well the heart is pumping out blood and decide in diagnosing heart failure (HF). Normally the percentage of EF is above 50%. A decrease in EF will make it difficult to perform anesthesia during surgery due to life-threatening arrhythmia, leading to sudden cardiac arrest and death. Patients with reduced ejection fraction need identification of risk factors, preoperative evaluation and optimization, correct medical therapy, adequate monitoring, and appropriate anesthetic technique and drugs. In this report, we present a 46-year-old man with reduced ejection fraction 30% and coronary artery disease who underwent below knee amputation surgery under spinal anesthesia. Spinal anesthesia was performed on the patient using low dose bupivacaine and fentanyl as adjuvant. Management of patients is aimed at maintaining adequate preload, avoiding tachycardia and arrhythmia along with maintaining afterload by maintaining a balance between oxygen supply and demand. Thus in patients with reduced ejection fraction, who are posted for noncardiac surgeries, the more preferable and safer alternative is regional anesthesia as it reduces the sympathetic stress response