spinal anaesthesia

Ischemic heart disease may occur in isolation, or in combination with the pathological process of vascular ageing, arteriosclerosis. These two conditions have differing impacts on the haemodynamic changes in response to anaesthesia and surgery. Hypertension is not a feature of ischemic heart disease, and vice versa, but where the two conditions co-exist, hypertension aggravates and accelerates the pathological processes of ischemic heart disease. Patients older than 40 yrs. presenting for anaesthesia and surgery must therefore be considered at risk of any combination of these three conditions. Anaesthetic techniques must also be chosen to minimize haemodynamic changes which in the normal healthy patient cause no serious morbidity, but which, in the patient with ischemic heart disease, can lead to serious morbidity or death. Here we report a 70 years old (BMI of 23.3) elderly, hypertensive Male patient with ischemic heart disease with previous MI (EF of 40% - 5%) undergoing elective Inguinal hernia repair. We Opted Spinal anesthesia over General anaesthesia as it should be an asset in cardiac patients undergoing non-cardiac lower abdominal surgeries to reduce preload and after load, stress response, coagulation responses, improves coronary perfusion, provides better postoperative analgesia, reduces incidence of perioperative MI, maintains myocardial oxygen supply demand ratio and avoids harmful effects of GA such as hypotention due to intravenous induction drugs, tachycardia and hypertension due to pressor response during direct laryngoscopy and tracheal intubation.

A knee arthroscopy in spinal anaesthesia was performed on a 67 years old male patient. During the procedure the patient was hemodynamically stable, until he suddenly turned pale and started complaining of severe pain in lower abdomen with signs of guarding. The procedure was finished as urgently as possible and after releasing the tourniquet we noticed significant difference in volume of the leg, with redness distal to tourniquet. Urgent lab results were essentially unremarkable and the patient was sent for the urgent radiological diagnostics. CD of the left leg described fluid in the soft tissues of the thigh, scrotum, and abdomen; and the unenhanced CT of the abdomen showed free fluid along the entire femoral shaft of the left thigh, extending towards pelvis and abdomen to perihepatic and perisplenic space, and retroperitoneum, with gas bubbles tracking along anterior aspect of the left thigh into the left retroperitoneum. He was admitted to the ICU, and within few hours all symptoms have resolved and his further recovery was without complications.

Background: To enhance the duration of sensory anaesthesia and to prolong the duration of post-operative pain relief during spinal anaesthesia, various adjuvants have been tried along with local anaesthetic agent. The present study was undertaken to evaluate and compare the onset and duration of sensory block, motor block and duration of post-operative pain relief by using intrathecal 0.5% Hyperbaric bupivacaine with fentanyl 25µg versus only 0.5% Hyperbaric bupivacaine selected groups.Methods: We enrolled 70 ASA Ι & ΙΙ patients undergoing surgeries below umbilicus level for our Prospective Randomized trial. Those who met our inclusion criteria were randomized using simple random sampling technique, after obtaining informed consent. Patients in Group A received fentanyl 25µg with 0.5% Hyperbaric Bupivacaine and patients in Group B received only 0.5% Hyperbaric Bupivacaine intrathecally. Parameters like onset and duration of sensory and motor block and postoperative pain relief were observed. In postoperative period, VAS score was monitored & time for rescue analgesia was noted, when VAS exceeded 5 or above.Results: It was found that Patients in Group A had significantly prolonged duration of postoperative analgesia as compared to Group B (Z value 17.35). Results of Onset & Duration of sensory and motor block were suggesting insignificant result. Post-operative complication was insignificant in our study.Conclusion: Addition of Fentanyl 25µg with 0.5% Hyperbaric Bupivacaine in Spinal anaesthesia have insignificant effect on duration of sensory and motor blockade and prolongs postoperative pain relief.