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SADDLE BLOCK FOR MANAGING A PATIENT WITH SEVERE HEART FAILURE UNDERGOING PERINEAL SURGERY
ESRA Academy. Gnanamuttu A. Sep 8, 2016; 138229
Topic: Geriatric Population
Dr. Anush Gnanamuttu
Dr. Anush Gnanamuttu

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Abstract
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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.

Methods:

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

Results:

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. 

Conclusions:

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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