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Neuraxial Anesthesia in Patients With Aortic Stenosis: A Systematic Review
Nika Samadzadeh Tabrizi1, Riley A Demos2, Roman Schumann3
1Albany Medical College, Albany, NY.
Journal of Cardiothoracic and Vascular Anesthesia
|October 25, 2023
Summary
Neuraxial anesthesia (NA) may be safe for carefully selected aortic stenosis (AS) patients, challenging previous contraindications. This review found manageable hypotension, with no cardiovascular collapse or mortality in the studied AS population.
Area of Science:
- Anesthesiology
- Cardiovascular Medicine
Background:
- Neuraxial anesthesia (NA) has been historically contraindicated in patients with aortic stenosis (AS) due to theoretical risks of hemodynamic instability.
- This contraindication is based on expert opinion rather than empirical scientific evidence.
Approach:
- A systematic review of PubMed, Embase, and Web of Science was conducted to identify studies on NA in patients with AS.
- Included studies focused exclusively on patients receiving NA for noncardiac, obstetric, or cardiac procedures.
- Data on intraoperative and postoperative complications were extracted and descriptively analyzed due to significant heterogeneity.
Key Points:
- The review analyzed 61 studies comprising 3,228 patients with AS who underwent procedures with NA (predominantly spinal and epidural anesthesia).
- Hypotension requiring vasopressors was the most frequent intraoperative complication, but it was resolved in all cases without reported cardiovascular collapse or mortality.
- Significant heterogeneity in anesthetic techniques and outcome measures precluded formal meta-analysis.
Conclusions:
- The findings suggest that NA might be a viable option for carefully selected patients with AS, challenging the absolute contraindication.
- Further prospective studies are warranted to compare NA with general anesthesia in this patient population and to clarify optimal dosing strategies.
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