The Anesthetic Management of a Patient With Advanced Heart Failure Undergoing Non-cardiac Surgery

TL;DR

This paper discusses using regional anesthesia for a patient with severe heart failure undergoing non-cardiac surgery, showing it can be a safe alternative to general anesthesia.

Contribution

The study demonstrates the successful use of ultrasound-guided regional anesthesia in a high-risk cardiac patient on antiplatelet therapy.

Findings

Ultrasound-guided brachial plexus block was safely used in a patient with severe heart failure and a pacemaker.

The patient experienced no hemodynamic instability during surgery and was discharged after 24 hours.

Regional anesthesia can be a viable option for high-risk cardiac patients undergoing non-cardiac procedures.

Abstract

Severe heart failure (HF) is associated with high perioperative morbidity and mortality during non-cardiac surgery. Anesthetic management for patients with critically reduced left ventricular ejection fraction (LVEF) requires strategies that minimize myocardial depression and autonomic instability. We present the case of a 73-year-old male with severe HF (LVEF 18%), a permanent pacemaker, severe anemia, and ongoing clopidogrel therapy who required urgent fixation of an open distal humerus fracture. General anesthesia was considered prohibitively high risk. An ultrasound-guided supraclavicular brachial plexus block was performed using 20 mL of 0.5% ropivacaine. Surgery proceeded uneventfully without hemodynamic instability, and the patient was discharged from the ICU after 24 hours.

Regional anesthesia provides significant hemodynamic advantages in high-risk cardiac patients. Ultrasound guidance allows for precise needle placement and may reduce complications, even in patients receiving antiplatelet therapy, when the benefits outweigh the risks. An ultrasound-guided supraclavicular block proved to be a safe and effective anesthetic strategy in a patient with severe HF undergoing emergency orthopedic surgery.

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