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

Mamta Jain1, Nitu Yadav1, Anish K Singh1

  • 1Anesthesia, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND.

Cureus
|June 6, 2022
PubMed

Insights

Anesthetic management for ischemic heart disease (IHD) patients with low ejection fraction undergoing surgery can safely utilize graded epidural anesthesia. This approach balances myocardial oxygen supply and demand, offering a viable alternative to general anesthesia.

Area of Science:

  • Anesthesiology
  • Cardiology
  • Nephrology

Background:

  • Ischemic heart disease (IHD), or coronary artery disease, stems from blocked coronary arteries reducing myocardial blood supply.
  • Managing IHD patients during non-cardiac surgery requires balancing myocardial oxygen supply and demand.
  • Low ejection fraction in IHD patients presents unique anesthetic challenges.

Observation:

  • A case report details the anesthetic management of an IHD patient with low ejection fraction undergoing percutaneous nephrolithotomy in the prone position.
  • Graded epidural anesthesia with low-dose local anesthetic and opioid was administered.
  • The prone position adds complexity to anesthetic management in these patients.

Findings:

  • Graded epidural anesthesia was successfully implemented.
  • This technique effectively managed myocardial oxygen supply and demand.
  • The patient tolerated the procedure well under this anesthetic approach.

Implications:

  • Graded epidural anesthesia is a safe alternative to general anesthesia for IHD patients with low ejection fraction.
  • It mitigates surgical stress response and provides excellent postoperative pain relief.
  • This method avoids myocardial depressant drugs and adverse coagulation effects, crucial for high-risk patients.

Keywords:
adverse cardiac eventsanesthetic goalscoronary artery diseasemyocardial ischemiapercutaneous nephrolithotomy

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