Decreased heart rate and blood pressure in a recent cardiac transplant patient after spinal anesthesia

Abstract

P Pu ur rp po os se e: : To describe the cardiovascular effects of neuraxial blockade in a heart transplant patient.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 69-yr-old 70-kg male underwent orthotopic heart transplant (bicaval anastomosis technique) for ischemic cardiomyopathy. Five months after transplantation, the patient underwent a transurethral bladder tumour resection under spinal anesthesia. Two millilitres of bupivacaine 0.75% (15 mg) were injected intrathecally at L 3-4 and the patient remained seated for approximately 20 sec prior to assuming the lithotomy position. Subsequently, both blood pressure (BP) and heart rate (HR) diminished gradually (BP and HR immediately pre-spinal: 113 mmHg (mean arterial pressure) and 92 beats·min -1 , respectively; nadir BP and HR: 94 mmHg (16.8% decrease) 30 min postspinal and 73 beats·min -1 (20.7% decrease) 40 min postspinal, respectively). HR and mean BP were highly correlated (r = 0.9410, P < 0.0001, R 2 = 0.8854). The dermatome level of neuraxial anesthesia, determined by sensitivity to pin prick, was T 8 (five minutes) and T 6 (ten minutes) postinjection of spinal anesthetic. Control patients (n = 10) undergoing elective urological procedures with identical anesthesia management demonstrated very similar cardiovascular responses.

Spinal anaesthesia with intravenous sedation for total hip arthroplasty in two patients with a history of orthotopic heart transplantation

“…Intrathecal isobaric ropivacaine has been demonstrated to cause less hypotension compared to hyperbaric bupivacaine when administered for caesarean section in the obstetric population [7]. Bupivacaine and ropivacaine of varying baricity and doses have also been used with similar haemodynamic stability in the heart transplant recipient population [2][3][4][5]. It remains unclear how larger doses or additives (e.g.…”

“…Several small studies and case reports exist in the literature describing the use of neuraxial anaesthesia in patients who have previously undergone cardiac transplantation. These have reported the safe use of both isobaric and hyperbaric bupivacaine and the use of combined spinal epidural anaesthesia in a range of patient populations undergoing different types of surgery [2][3][4][5]. Only one of these reports explicitly mentions the use of procedural sedation with intravenous midazolam in addition to the neuraxial anaesthesia technique chosen [3].…”

“…Several small studies and case reports exist in the literature describing the use of neuraxial anaesthesia in patients who have previously undergone cardiac transplantation. These have reported the safe use of both isobaric and hyperbaric bupivacaine and the use of combined spinal epidural anaesthesia in a range of patient populations undergoing different types of surgery [2–5]. Only one of these reports explicitly mentions the use of procedural sedation with intravenous midazolam in addition to the neuraxial anaesthesia technique chosen [3].…”

Anesthesia management for cesarean section 10 years after heart transplantation: a case report

“…No matter what anesthesia method to perform, we should maintain hemodynamic stable and protect cardiac function, and keep mother and baby safe. Both general and intravertebral anesthesia were successfully performed in heart transplanted patients (Valerio et al 2014 ; Allard et al 2004 ). But for pregnant women, the better anesthesia choice is intravertebral anesthesia which produces less impact on baby compared with general anesthesia.…”

Cardiovascular alterations in the parturient undergoing cesarean delivery with neuraxial anesthesia

“…Although these cases may result from cardioaccelerator fiber blockade, other cardiac mechanisms are more likely responsible. A sudden decrease in preload activates intrinsic cardiac receptors such as baro receptors in the right atrium, mechanoreceptors in the left ventricle, or receptors in cardiac pacemaker cells leading to a decrease in HR; this mechanism is supported by the observation that HR decreases in transplanted hearts after spinal anesthesia [94].…”