Simulation Scenario- Myocardial Ischemia in a Patient With a Cardiac Transplant After Subarachnoid Block

Abstract

Abstract This resource is a simulation scenario originating from a case experienced in the operating room. In this scenario, an 80-year-old male, who had a cardiac transplant 13 years prior, undergoes a spinal anesthetic for a wide local excision of Merkel cell carcinoma in his right thigh and thereafter develops refractory hypotension and subsequent myocardial ischemia. Sympathectomy and hypotension are well-known complications of a subarachnoid block. Identification and treatment of these common occurrences are considered basic principles in the use of neuraxial blocks. In a patient with a transplanted heart, the physiology involved can be further complicated as patients are preload dependent. This scenario exposes participants to the extreme complications of a subarachnoid block (hypotension and myocardial ischemia) in a patient with a cardiac transplant, as well as to the complicated responses to different treatments.

Keywords

• Hypotension
• Myocardial Ischemia
• Subarachnoid Block