[Epidural anesthesia for ileocecectomy in a patient with severe aortic stenosis]

Severe aortic stenosis is a significant risk factor for perioperative cardiac morbidity and mortality in patients undergoing noncardiac surgery. We experienced a case of a 74-year-old female with symptomatic aortic stenosis who underwent ileocecectomy for ileocecum cancer. She frequently complained of chest pain and fell into syncope when she walked a short distance. Preoperative catheter study revealed severe aortic stenosis in which valve area was 0.5 cm2 and pressure gradient between the left ventricle and the aorta was 101 mmHg. To avoid abrupt hemodynamic change that would accompany induction of and emergence from general anesthesia, we chose epidural anesthesia. Though hypotension was expected following epidural anesthesia, adequate fluid loading and intermittent phenylephrine administration was effective for maintaining hemodynamic stability throughout the operation. Perioperative course was uneventful with no cardiac complication.