Korean J Anesthesiol.  2014 Aug;67(2):129-132. 10.4097/kjae.2014.67.2.129.

Combined spinal-epidural anesthesia for lumbar discectomy in a patient with asymptomatic severe aortic stenosis: a case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea. bglim9205@korea.ac.kr

Abstract

The use of neuraxial anesthesia has traditionally been contraindicated in patients with severe aortic stenosis. However, general anesthesia can be riskier than neuraxial anesthesia for severe aortic stenosis patients undergoing spinal surgeries in the prone position as this can cause a major reduction in cardiac output secondary to diminished preload. In addition, general anesthesia, muscle relaxation, and positive-pressure ventilation can decrease venous return and reduce vascular tone, further compromising cardiac output. Combined spinal-epidural anesthesia with closely monitored, careful titration of the local anesthetic dose can be an efficient and safe anesthetic method for managing such patients. We describe the successful management of combined spinal-epidural anesthesia in an asymptomatic severe aortic stenosis patient scheduled for lumbar discectomy.

Keyword

Aortic stenosis; Combined spinal epidural anesthesia; Dexmedetomidine; Regional anesthesia

MeSH Terms

Anesthesia*
Anesthesia, Conduction
Anesthesia, General
Aortic Valve Stenosis*
Cardiac Output
Dexmedetomidine
Diskectomy*
Humans
Muscle Relaxation
Positive-Pressure Respiration
Prone Position
Dexmedetomidine
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