Selective Spinal Anesthesia in a Patient with Low Ejection Fraction Who Underwent Emergent Below-Knee Amputation in a Resource-Constrained Setting

A Successful Awake Fiberoptic Bronchoscopy Intubation of a Cardiomorbid Patient: A Case Report

ABSTRACT

Bronchoscopy is a widely used technique for diagnostic and therapeutic purposes. Though it requires anesthesia, many options are available, depending on the patient's health status, the purpose of the procedure, and the type of bronchoscope used. One such health status is heart failure, a leading cause of death, and a common challenge of anesthesiology. We report a 60-year-old male patient who is a known case of heart failure with an ejection fraction of 15%, and an implanted cardioverter defibrillator, along with concurrent ischemic heart disease, diabetes mellitus, and hypertension, who presented complaining of dysphagia. This highly morbid patient was able to successfully undergo a bronchoscopic biopsy with nerve block anesthesia considering his inadequacy for conventional methods. This report aims to shed light on these challenging cases and alert anesthesiologists on how to manage such situations in patients with cardiac morbidities.

Caesarean section under spinal anesthesia for a mother with dilated cardiomyopathy in a resource-limited setting: a case report

Introduction and importance

Peripartum cardiomyopathy is an uncommon form of cardiomyopathy that develops in the latter stages of pregnancy or in the first few weeks following delivery. Anaesthetic management of caesarean section of a parturient with dilated cardiomyopathy is challenging due to its nature of impaired ventricular contractility coupled with cardiovascular changes during pregnancy. This is significantly worse in a resource-constrained environment with restricted access to medications and equipment.

Case presentation

We report a case of a 31-year-old multigravida parturient presented with a diagnosis of dilated cardiomyopathy and a low ejection fraction undergoing emergency caesarean section. Successful management of a parturient with dilated cardiomyopathy undergoing a caesarean section under spinal anaesthesia is reported in this case report.

Clinical discussion

Spinal anaesthesia is another alternative for the successful management of patients with dilated cardiomyopathy (DCM) using a low dose of bupivacaine with intrathecal adjuvants. Our report indicates that caesarean section also may be managed safely with spinal anaesthesia alone in patients with DCM, by using low-dose bupivacaine and intrathecal morphine. The slight haemodynamic changes were adjusted with fluid infusion. The use of vasopressors was not required to manage the hypotension.

Conclusion

General anaesthesia, epidural alone, and epidural combined with spinal anaesthesia are the widely used anaesthetics techniques for caesarean section in patients with heart disease. Spinal anaesthesia with low-dose bupivacaine with opioids is another suitable choice. The case report is written according to the CARE guideline (https://www.care-statement.org).