The Anesthetic Management of a Patient With Advanced Heart Failure Undergoing Non-cardiac Surgery

Severe heart failure (HF) is associated with high perioperative morbidity and mortality during non-cardiac surgery. Anesthetic management for patients with critically reduced left ventricular ejection fraction (LVEF) requires strategies that minimize myocardial depression and autonomic instability. We present the case of a 73-year-old male with severe HF (LVEF 18%), a permanent pacemaker, severe anemia, and ongoing clopidogrel therapy who required urgent fixation of an open distal humerus fracture. General anesthesia was considered prohibitively high risk. An ultrasound-guided supraclavicular brachial plexus block was performed using 20 mL of 0.5% ropivacaine. Surgery proceeded uneventfully without hemodynamic instability, and the patient was discharged from the ICU after 24 hours. Regional anesthesia provides significant hemodynamic advantages in high-risk cardiac patients. Ultrasound guidance allows for precise needle placement and may reduce complications, even in patients receiving antiplatelet therapy, when the benefits outweigh the risks. An ultrasound-guided supraclavicular block proved to be a safe and effective anesthetic strategy in a patient with severe HF undergoing emergency orthopedic surgery.