Ejection Fraction <35% - Anaesthetic Experience of 236 Cases: A Retrospective Study

Abstract

Background: EF is an important measurement in determining how well the heart is pumping out blood and in diagnosing as well as tracking the heart failure (HF). Normal EF varies at 55% to 70%, while EF 40% to 55% may indicate damage perhaps from previous heart attack, but may not indicate HF. However, measurement under 40% may show evidence of HF or cardiomyopathy and patient with EF&lt; 35% may be at the risk of life threatening irregular heartbeats. Such patients are considered to be at high risk for anaesthesia as life threatening irregular heartbeats lead to sudden cardiac arrest and sudden death.Objectives: The aim of this study was to find out the characteristics of patients, identifying of the risk factors, better understanding of pathophysiology, pre-operative optimization of the patients, uses of stable drugs &amp; anesthetic techniques, reduces intraoperative or early postoperative complications &amp; perioperative morbidity, mortality.Methods: In this retrospective study we described our experiences of 236 cases of very low ejection fraction (20% - 35%) from 1st July 2014 - 30th June 2017. We reviewed their medical history and noted age, sex, type of operation &amp; anesthesia, pattern of operation either elective or emergency, preoperative investigation and preparation, as well as details of anaesthetic management, were also recorded.Results: General anaesthesia was performed in 176 (74.58%) cases and rest of 60(25.42%) cases were regional where spinal 42(17.80%) cases &amp; epidural 18(7.62%) cases. The age of the patients were in the range of 20 to 70 years, with majority of the patients were in 60 to 69 years age group. The majority of the patients about 46.19% were in LVEF 26 - 30% group, 36.01% patients were in 31 - 35% group and rest of 17.80% patients were in 20 - 25% group. Average duration of operation incase of general anesthesia 66.5(±2.28SD) min and incase of regional 44.2(±3.25SD) min. The mortality rate only 1.27%.Conclusions: Preoperative patient optimization, intraoperative haemodynamic stability and postoperative care have contributed to the success of very low ejection fraction patients in our hospital.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 114-120

Anaesthetic management in the patient with thoracic–lumbar intradural tumor accompanied by heart failure and atrial fibrillation: a case report

“…In diastolic heart failure, heart muscle contracts normally, but the ventricles do not relax as they should during ventricular filling. 7,9 Impaired diastolic function was an important finding that also occurred in our case. Normal sinus rhythm was required to gain optimal diastolic filling.…”

“…9 Any life-threatening arrhythmia that might occur in this patient needs preventive treatments and prompt treatments; otherwise, it might lead to sudden cardiac arrest or sudden death. 7,9 Heart failure with preserved ejection fraction (HFpEF), which is known as diastolic heart failure, is when the left ventricle loses its ability to relax normally because the cardiac muscle has become stiff. The heart can't properly fill with blood during the resting period between each beat.…”

“…In HF, myocardial remodeling usually continues and causes the clinical syndrome of HF. [8][9][10] Heart failure is classified as HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), or HF with mid-range ejection fraction (HFmrEF). HF-pEF shows impaired muscle relaxation and impaired left ventricular filling.…”

Sequential Combined Spinal-epidural Anesthesia in a Multiple Comorbidity Patient

“…The primary perioperative objective in patients with ischemic heart disease is to prevent perioperative myocardial ischemia by maintaining equilibrium between oxygen delivery and consumption, and treating accordingly if such an imbalance should occur, irrespective of the type of anesthetic technique employed or drug used. [ 3 ]…”