Local and Regional Anesthesia (Jan 2021)
Spinal Anesthesia Using Ultra-Low-Dose Isobaric Bupivacaine with Intrathecal Morphine-Fentanyl for Bilateral Low Extremity Procedures in a Geriatric Patient with Recent Myocardial Infarction and Percutaneous Coronary Intervention
Abstract
Ambrose Rukewe,1,2 Linea Nanyalo-Nashima,2 Nicola Olivier2 1University of Namibia, School of Medicine, Surgery & Anesthesiology Department, Hage Geingob Campus, Windhoek, Namibia; 2Department of Anaesthesia, Windhoek Central & Katutura State Hospitals, Windhoek, NamibiaCorrespondence: Ambrose RukeweUniversity of Namibia, School of Medicine, Surgery & Anesthesiology Department, Hage Geingob Campus, Windhoek, NamibiaTel +264-81-484-0892Email [email protected]: A recent inferior ST-elevation myocardial infarction and percutaneous coronary intervention in an elderly female patient scheduled for bilateral lower extremity operations simultaneously represent significant risks for re-infarction and mortality. Our index patient required an above-knee amputation of the left leg to prevent infection/progressing gangrene as well as application of a back-slab for the conservative management of a fractured right femur. We employed spinal injection of ultra-low-dose 0.5% isobaric bupivacaine 4 mg with morphine 75 mcg plus fentanyl 10 mcg which provided adequate anesthesia for radical amputation, effective postoperative analgesia and good hemodynamic stability.Keywords: recent myocardial infarction, percutaneous coronary intervention, geriatric, bilateral lower extremity operations, ultra-low-dose, isobaric bupivacaine
