Case report
Anaesthetic Management in a Patient with Severe Left Ventricular Dysfunction Undergoing Lumbar Laminectomy and Spinal Fixation: A Case Report
UD09-UD11
Correspondence
Pranav Ashok Gurrapu,
Resident Boys Hostel, JNMC, Sawangi (Meghe), Wardha-442107, Maharashtra, India.
E-mail: pranavgurrapu@gmail.com
Severe Left Ventricular Systolic Dysfunction (LVSD), in addition to serious valve heart disease, presents a daunting challenge for anaesthesiologists in non-cardiac surgery. We present the case of a 75-year-old woman scheduled for L3 laminectomy and spinal fixation due to lumbar canal stenosis. She had an Ejection Fraction (EF) of 20%. On pre-operative assessment, severe LVSD with valvular lesions was noted. Anaesthesia was induced with etomidate, fentanyl, and vecuronium to minimise cardiac stress and maintain stable blood flow. Arterial and central venous lines were placed for continuous monitoring. Anaesthesia was maintained with a mixture of oxygen, air, and sevoflurane. Infusions of noradrenaline and dobutamine were adjusted to maintain stable blood pressure. The patient was positioned with care to avoid venous compression and to maintain preload. Fluid administration was performed very cautiously to avoid overload. She remained stable throughout the procedure and was extubated uneventfully. Later, she was transferred to the intensive care unit for close monitoring during recovery. This case illustrates that careful anaesthetic planning, close monitoring, appropriate fluid management, and proactive support are of paramount importance in high-risk cardiac patients for spine surgery, since even slight changes in blood flow can lead to major complications.