Local and Regional Anesthesia (Oct 2020)
Selective Spinal Anesthesia in a Patient with Low Ejection Fraction Who Underwent Emergent Below-Knee Amputation in a Resource-Constrained Setting
Abstract
Hailemariam Mulugeta, Abebayehu Zemedkun, Hailemariam Getachew Department of Anesthesiology, College of Medicine and Health Science, Dilla University, Dilla, EthiopiaCorrespondence: Hailemariam MulugetaDepartment of Anesthesiology, College of Medicine and Health Science, Dilla University, PO Box 419/13, Dilla, EthiopiaTel +251 97 041 5208Fax +251 46 331 0894Email [email protected]: Patients with congestive heart failure have a high risk of perioperative major adverse cardiac events and death. The major perioperative goal of management in patients with low ejection fraction is maintaining hemodynamic stability. Evidence is scarce on the safety of a certain anesthetic technique for patients with heart failure. In this report, we present a 48-year-old man with ischemic dilated cardiomyopathy and low-output congestive heart failure (estimated ejection fraction of 27%) who underwent emergent below-knee amputation under selective spinal anesthesia without any apparent complications. We believe that selective spinal anesthesia can be a useful alternative anesthetic technique in patients with low ejection fraction undergoing emergent lower limb surgery. We showed evidence-based and customized anesthetic management of a high-risk patient with the available equipment and resources. This report will hopefully show the contextual challenges of the perioperative care of critically ill patients in resource-constrained settings.Keywords: congestive heart failure, low ejection fraction, dilated cardiomyopathy, neuraxial anesthesia, cardiovascular effects, spinal anesthesia spread, factors
