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 (CESA) 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 estimate the changes in hemodynamic, the vasopressor use, surgeons, and patient satisfaction.
Patients and Methods: Sixty adult cardiac patients (5 with pulmonary hypertension, SPAP > 50 mmHg) fifty -five with low systolic function (EF 40%) planned for a lower body procedures were included to our study. The CSEA technique was done with patients receiving spinal anesthesia with 5mg 0.5% hyperbaric bupivacaine plus 20ug fentanyl, followed by an epidural top-up of 5 ml 0.25% isobaric bupivacaine. Hemodynamic parameters, block characteristics were recorded