ESRA Academy. Gnanamuttu A. Sep 8, 2016; 138229; 0046 Topic: Geriatric Population
Dr. Anush Gnanamuttu
Dr. Anush Gnanamuttu

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Background and Aims:

Anaesthesia for patients with severe heart failure can be a challenge especially in  those with a low ejection fraction. We report our experience in managing such a patient for emergency perineal surgery.


Our patient was a 79 year old male with a big perianal abscess which had failed to respond to antibiotics. His comorbidities include severe heart failure with an echo showing an ejection fraction of 15%. The left ventricle was moderately dilated with severely hypokinetic walls. His exercise tolerance was 10 meters.  He also had COPD (FEV1-43% predicted) and has had radiotherapy for squamous cell carcinoma of lung. His saturations were 95%, pulse rate of 88 and blood pressure of 97/38. Drug history included furosemide, Lisinopril and spiriva


After siting an arterial line, a saddle block was achieved with 6mg of 0.5% bupivacaine with the patient sitting for 20 minutes. The block was limited to L4/5. The patient was haemodynamically stable intra-operatively with no need for vasopressors. He had an uneventful recovery and discharged back to the ward. 


Patients with heart failure are at high risk of perioperative complications including death, coronary events and heart failure exacerbations. Those with low ejection fraction (<30%) have significantly worse prognosis. The anaesthetic goals in managing these patients are to maintain afterload with minimal myocardial depression. A saddle block will be able achieve both, provide good analgesia and prevent the stress response to surgery. A saddle block is an excellent technique in situations which allow for surgery to be conducted under it.

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