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[Spinal anesthesia in a patient with idiopathic hypertrophic cardiomyopathy]
M Kondo1, Y Takino, H Morisaki
1Department of Anesthesiology, Second Tokyo National Hospital.
Insights
Spinal anesthesia may be safe for patients with idiopathic hypertrophic cardiomyopathy if adequate fluid management maintains blood pressure. This approach, carefully monitored, can prevent complications during bladder tumor surgery.
Area of Science:
- Cardiology
- Anesthesiology
- Urology
Background:
- Idiopathic hypertrophic cardiomyopathy (IHC) often contraindicates spinal anesthesia due to risks of hypotension.
- Transurethral resection of urinary bladder tumors (TURBT) requires careful anesthetic management.
Observation:
- A patient with IHC underwent TURBT under spinal anesthesia.
- Myocardial oxygen supply-demand ratio was maintained through cautious anesthetic administration.
- Central venous pressure (CVP) was monitored, and crystalloid infusion maintained pre-anesthetic levels to prevent hypotension.
Findings:
- The patient remained hemodynamically stable throughout the surgical procedure.
- Adequate preload preservation and avoidance of hypotension were key to successful anesthesia.
Implications:
- Spinal anesthesia may be a viable option for TURBT in IHC patients.
- Careful hemodynamic monitoring and fluid management are crucial for patient safety.
- This case challenges the absolute contraindication of spinal anesthesia in IHC.
Abstract:
Transurethral resection of urinary bladder tumor was performed under spinal anesthesia which has been considered to be rather contraindicated in a patient with idiopathic hypertrophic cardiomyopathy. Caution was exercised not to compromise myocardial oxygen supply demand ratio. Central venous pressure (CVP) was continuously monitored and crystalloid solution was infused to maintain CVP in pre-anesthetic level, thereby preventing the reduction in arterial pressure. The patient was hemodynamically stable throughout the operation. This case indicates that if adequate preload could be preserved and hypotension avoided, spinal anesthesia may not be precluded in patients with idiopathic hypertrophic cardiomyopathy.