Neuraxial Anesthesia at Knee Amputation in Patient with Heart Failure
Anestezi Dergisi, cilt.31, ss.311-313, 2023 (Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 31
- Basım Tarihi: 2023
- Dergi Adı: Anestezi Dergisi
- Derginin Tarandığı İndeksler: Scopus, Academic Search Premier, Central & Eastern European Academic Source (CEEAS), EMBASE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.311-313
- Anahtar Kelimeler: amputation, heart failure, high risk procedure, Neuraxial anesthesia, perioperative risk
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Cardiovascular diseases are encountered very frequently in anesthesia practices and are a significant cause of perioperative morbidity and mortality. This case report provides an anesthetic approach in the lower extremity amputation surgery of a patient with congestive cardiac failure besides insulin-dependent diabetes mellitus, hypertension and chronic renal failure. Case: A male patient aged 61 years, scheduled for amputation below the right knee due to diabetic foot, had hypertension, chronic renal failure, diabetes mellitus, coronary artery disease and congestive cardiac failure and used furosemide, clopidogrel, insulin, proton pump inhibitor, and inhaler. The patient who had a history of cardiac arrest a month ago had ejection fraction of 25% on echocardiography, left bundle branch block on electrocardiogram, and pleural effusion image on chest radiography. The patient who was evaluated as ASA IV was applied a standard monitorization. Using a 22-gauge Quincke spinal needle under aseptic conditions from the L4-L5 interval, the spinal anesthesia with 5 mg bupivacaine heavy and 30 microgram fentanyl was administered on the basis of midline approach. The surgical operation was initiated when the sensory block level was T12. For sedation, intravenous 1 mg dormicum was administered. The blood pressure during the operation was stable and the initial blood pressure was 129/71 mmHg, heart rate was 81 beats/min, and oxygen saturation was 99% in the postoperative recovery room. The patient was transferred to the service without any problem. Conclusion: General anesthesia causing vasodilation and loss of sympathetic tonus, results in reduction in blood pressure both in induction and maintenance by disruption of the normal heart-lung interaction induced by mechanical ventilation. According to a retrospective study analyzing intraoperative hemodynamic status in 57 ASA IV patients who underwent above-the-knee amputation by applying peripheral nerve block, the majority of patients were hemodynamically stable apart from 10 patients requiring vasopressor during surgery. A subarachnoid block was preferred to decrease the drugs used and to use less sedative agents in this case. We believe that neuraxial anesthesia performed using appropriate doses and drug combinations in comorbid patients with low ejection fraction can reduce perioperative morbidity and mortality by ensuring stable hemodynamics.