Bilateral brachial plexus blocks in a patient of hypertrophic obstructive cardiomyopathy with hypertensive crisis

Area of Science:

• Anesthesiology
• Cardiology
• Trauma Surgery

Background:

• Hypertrophic obstructive cardiomyopathy (HOCM) presents significant anesthetic challenges due to complex pathophysiology and potential perioperative complications.
• Patients with HOCM often have co-morbidities like hypertension and diabetes, increasing surgical risks.
• Emergency surgical interventions in HOCM patients require careful anesthetic planning to mitigate risks.

Purpose of the Study:

• To present a case of successful anesthetic management for emergency surgery in a patient with HOCM.
• To highlight the utility of bilateral brachial plexus blocks in a high-risk surgical scenario.
• To discuss the considerations for regional anesthesia in patients with complex cardiac conditions.

Main Methods:

• A 50-year-old male with known HOCM, hypertension (crisis), and diabetes underwent emergency limb trauma surgery.
• Anesthesia was achieved using bilateral brachial plexus blocks, with careful attention to local anesthetic dosage and staggered administration.
• Invasive monitoring and labetalol infusion were used for blood pressure management.

Main Results:

• The patient successfully underwent emergency hemostasis and debridement of traumatic limb injuries under bilateral brachial plexus blocks.
• The regional anesthesia technique effectively managed the patient's co-morbidities, including hypertensive crisis.
• No local anesthetic toxicity was observed, indicating successful management of anesthetic risks.

Conclusions:

• Bilateral brachial plexus blocks can be a safe and effective anesthetic option for emergency procedures in select HOCM patients.
• Meticulous technique and careful dose calculation are crucial to prevent local anesthetic systemic toxicity (LAST).
• Regional anesthesia, when carefully planned, can be a viable alternative to general anesthesia in high-risk surgical patients.