Low-Dose Sequential Combined Spinal–Epidural: An Anesthetic Technique for Lower Body Surgery in Patients with Significant Cardiac Disease | ||||
| International Journal of Medical Arts | ||||
| Article 2, Volume 6, Issue 6, June 2024, Page 4486-4492 PDF (1.68 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ijma.2024.280477.1952 | ||||
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| Authors | ||||
Elsayed Mohamed Abdelazeem   ; Ibrahim Ezat Mostafa; Mohmed Fouad Elmeliegy
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| Department of Anesthesiology, Faculty of Medicine, Benha University, Qalyubiyya, Egypt | ||||
| Abstract | ||||
| Background: Anesthetic management for patients with significant cardiac disease is challenging and may be associated with high morbidity and mortality. Low-dose sequential combined spinal–epidural anesthesia [CSEA] is advantageous over single-shot spinal and epidural anesthesia as it provides rapid onset, efficacy, and minimal toxicity. Aim of the work: This study is planned to assess the safety of small-dose sequential CSEA in high-risk cardiac patients undergoing lower body surgeries and to estimate changes in hemodynamics, vasopressor use, surgeon satisfaction, and patient satisfaction. Patients and Methods: Sixty adult cardiac patients [5 with pulmonary hypertension, systolic pulmonary artery pressure > 50 mmHg] and fifty-five with low systolic function [ejection fraction < 40%] planned for a lower body procedure were included in our study. The CSEA technique was done with patients receiving spinal anesthesia with 5 mg 0.5% hyperbaric bupivacaine plus 20 μg fentanyl, followed by an epidural top-up of 5 ml 0.25% isobaric bupivacaine. Hemodynamic parameters and block characteristics were recorded. Results: There were no differences in the demographic data of the patients. No significant hemodynamic changes occurred during the procedure; hypotension happened in 5% of patients and bradycardia in less than 2% of patients. There were no arrhythmias or post-operative ECG changes, and postoperative troponin was negative. There was no postoperative nausea or vomiting. Conclusion: We conclude that low-dose sequential CSEA is a secure and efficacious method for patients with significant cardiac disease scheduled for lower body procedures. | ||||
| Keywords | ||||
| Anesthesia; Combined spinal epidural; Cardiac disease | ||||
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