Combined Spinal-Epidural Anaesthesia For Hip Arthroplasty In A Patient With Severe Left Ventricular Systolic Dysfunction And Distorted Spine Anatomy

Abstract

Background: Combined spinal-epidural anaesthesia in patients with low ejection fraction and cardiac systolic dysfunction is a challenge especially  when sensoryblock levels encroachon highthoracic segments. Cardio-accelerator sympathectomy following block onset can trigger cardiac decompensation which may lead to arrhythmias and cardiac arrest. Appropriate monitoring and early interventions in alteration in blood pressure, heart rate and rhythm are essential to a successful outcome.
Objective: To report a case of a 54-year-old male with a background severe left ventricular systolic dysfunction and previous lower lumbar spine surgery who had combined spinal-epidural anaesthesia for hip arthroplasty.
Method: Following set up of invasive blood pressure monitoring, a combined epidural and low dose sub-arachnoid anaesthesia at L1–2 and L2– 3 respectively was instituted. Blood pressure and heart rate were monitored and controlled within narrow limits with the aid of continuous invasive blood pressure monitoring, fluid and intermittent ephedrine boluses.
Conclusion: Combined spinal-epidural anaesthesia with invasive monitoring can be safely utilised for patients with severe left ventricular systolic dysfunction and distorted spine anatomy.

Key words: Spinal, epidural, ejection fraction, sympathectomy, arthroplasty