Graded Epidural Anesthesia for Non-cardiac Surgery in the Prone Position in a Patient With Low Ejection Fraction

Abstract

Ischemic heart disease (IHD), also known as coronary artery disease, occurs due to the blockage of coronary arteries which reduces the blood supply of the myocardium. The main goal of the anesthetic management of IHD patients undergoing non-cardiac surgery is to maintain the balance between myocardial oxygen supply and demand. Here, we report the anesthetic management of an IHD patient with a low ejection fraction who was posted for percutaneous nephrolithotomy in the prone position. We opted for graded epidural anesthesia with a low dose of a local anesthetic drug and opioid. Graded epidural anesthesia is a safe alternative over general anesthesia for patients with IHD and low ejection fraction as it reduces stress response to surgery, provides good postoperative analgesia, and avoids myocardial depressant drugs and coagulation responses.

Low Dose Combined Spinal-Epidural (CSE) Anaesthesia with Blocks for Management of A High-Risk Geriatric Patient with Dilated Cardiomyopathy Posted for TURBT

“…Mehdi Sanatkar et al also showed hemodynamic stability and no ST-T changes with low dose of bupivacaine and sufentanil in patients with CAD [11]. Jain M et al reported use a low dose of a local anaesthetic and an opioid during a graded epidural anaesthesia in patients w ith IHD and low ejection fraction posted for nephrolithotomy and observed a stable hemodynamic profile with adequate postoperative analgesia [12]. Due to the large network of venous plexus in the prostate gland's ability to absorb fluid, TURBT is often an hour-long treatment with an additional risk of fluid overload and TURP syndrome.…”