Continuous spinal anesthesia for elderly patients with cardiomyopathy undergoing lower abdominal surgeries

Abstract

Background: Anesthetic management, of patients with cardiomyopathy with reduced systolic function, is challenging and may be associated with high mortality. Continuous epidural anesthesia (CEA) is generally accepted as the routine method of regional anesthesia for vascular surgery of the lower limb. Continuous spinal anesthesia (CSA) has been reported to be more rapid in action, with good sensory and motor block, fewer hemodynamic disturbance and side effects when compared to continuous epidural anesthesia (CEA), and single dose spinal anesthesia (SDSA). Patients and methods: Forty adult patients with depressed systolic function (EF 45% or less) scheduled for lower abdominal surgeries were subjected to our study. Under full aseptic precautions subarachnoid space was accessed in the setting position by an epidural needle at L3–4 and 2 ml of hyperbaric bupivacaine (10 mg) was injected into subarachnoid space, then an epidural catheter was inserted in the subarachnoid space for 3 cm. Anesthesia was maintained by Top up doses of plain bupivacaine 0.5% 1.2 ml. Result: There were no differences in demographic characteristics of patients, procedure’s duration, and ASA physical status classification. There were no significant changes in hemodynamics throughout the procedure. Hypotension occurred in 5% of patients, bradycardia occurred in 10% of patients and arrhythmia occurred in 2.5% of patients. There were no postoperative ECG changes and postoperative Troponin was negative. There was no postoperative Neurological deficit or Post dural puncture headache. Conclusion: We can conclude that, CSA was effective and safe technique for patients with cardiomyopathy undergoing lower abdominal surgeries.

Keywords

• Spinal anesthesia continuous
• Cardiomyopathy
• Anesthesia