Spinal Anesthesia in a Patient with reduced Ejection Fraction undergoing Below-Knee Amputation
Main Article Content
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
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. doi: 10.3390/jcm5070062.
3. . Tayal U, Prasad S, Cook SA. Genetics and genomics of dilated cardiomyopathy and systolic heart failure. Genome Med. 2017;9(1):20. doi: 10.1186/s13073-017-0410-8
4. shaheen MSA, Sardar K, Chowdhury AN, et al. Ejection Fraction < 35% - Anaesthetic experience of 236 cases: A retrospective study. Anwer Khan Mod Med Coll J 2018; 9: 114–120.
5. Borlaug BA and Pauls WJ (2011). Heart failure with preserved ejection fraction: pathophysiology diagnosis and treatment. European Heart Journal 32 670-679.
6. Srinivasan NT, Schilling RJ. Sudden cardiac death and arrhythmias. Arrhythmia Electrophysiol Rev 2018; 7: 111–117
7. Gulpinar K, Ozdemir S, Ozis E, et al. A preliminary study: Aspirin discontinuation before elective operations; When is the optimal timing? J Korean Surg Soc 2013; 85: 185–190
8. Hedge, J, Balajibabu P, Sivaraman T. The patient with ischaemic heart disease undergoing non cardiac surgery. Indian J Anaesth 2017; 61: 705–711.
9. Andersson C, Mérie C, Jørgensen M, et al. Association of β-blocker therapy with risks of adverse cardiovascular events and deaths in patients with ischemic heart disease undergoing noncardiac surgery: A Danish nationwide cohort study. JAMA Intern Med 2014; 174: 336–344.
10. Mitiku Desalegn. Caesarean section under spinal anesthesia for a mother with dilated cardiomyopathy in a resourcelimited setting: a case report. Annals of Medicine & Surgery (2024) 86:1182–1184
11. Divya Senthilkumar1, Dilip K Govindan2 , Krishna Prasad T Anesthetic Management of Patient with Global Left
Ventricular Systolic Dysfunction Posted for Transurethral Resection of Prostrate and Bilateral Hernioplasty. SBV Journal of Basic, Clinical and Applied Health Science, Volume 5 Issue 1 (January–March 2022