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.