Liaquat Ali, Moazzam Ali, Umer Ali, Amjed Iqbal.
Unilateral spinal anesthesia for major lower limb surgery in patients with cardiac failure.
Pak Armed Forces Med J Nov ;66(1):62-7.

Objective: To determine the safety of unilateral spinal anesthesia in elderly patients with cardiac failure undergoing major lower limb surgery. Study Design: Prospective, quasi- experimental study. Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Rawalpindi, during the period of October 2012 to December 2013. Material and Methods: In this study, 20, American Society of Anesthesiologists (ASA) III and IV patients with different severities of heart failure due to previous myocardial infarction (MI), aged between 60-110 years undergoing unilateral lower limb orthopaedic surgery were included by non probability consecutive sampling. All patients received unilateral spinal anesthesia using hyperbaric 0.75% Bupivacaine 7.5mg. They were given preload of 2ml/kg colloid. Patients were placed in the lateral position with fractured limb on lower side and kept in this position for 10 minutes. Haemodynamic variations were monitored and recorded for the whole duration of procedure. Dobutamine, Ephedrine and Atropine were used as vasopressor/inotropic agents. Result: In this study 20 patients were included. Sixteen (80%) were male. Mean age of group was 80.8 ± 12.5 years. The mean duration of surgery in our patients was 63.55 ± 16.47 minutes. Ephedrine was needed in 12 patients, atropine in 4 patients. One patient required Dobutamin infusion and one patient required norepinephrine infusion for 15 minutes. Two patients did not require inotropic or vasopressor support. The average percent fall in mean arterial pressure from prespinal value was 20.59%. The block remained unilateral in all cases. Motor blockade was adequate in the limb to be operated. Conclusion: Unilateral subarachnoid block with hyperbaric bupivacaine does not produce adverse hemodynamic changes. Under controlled setting and meticulous monitoring elderly patients with variable degree of heart failure can be safely given unilateral spinal anesthesia for major lower limb orthopaedic surgery.

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