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Case Report

Epidural anesthesia in patients with ischemic heart disease and low ejection fraction who underwent non-cardiac operation: A case report

Brillyan Toar Jehosua, I Made Agus Kresna Sucandra.

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Anaesthetic management of patients with cardiac comorbidities who underwent non-cardiac surgery has always been challenging. The goal of anaesthesia management is to keep the myocardial oxygen supply greater than the demand to avoid ischemia. In this case report, anaesthetic implications included assessing the patientÂ’s cardiovascular status preoperatively with a selection of epidural anaesthesia (EA) and analgesia techniques. Incremental doses of local anaesthetic were given to maintain myocardial oxygen demand.
Case Illustration:
We reported a case of 52 years old female with nephrolithiasis dextra, severe hydronephrosis dextra, mild hydronephrosis sinistra, neglected DJ Stent dextra and chronic kidney disease stage V on regular hemodialysis who underwent percutaneous nephrolithotomy dextra and retrograde pyelogram dextra and sinistra. Pre-anaesthesia evaluation showed patients with the physical status of ASA III, CHF functional class II, low ejection fraction of 22%, regional wall motion abnormality and inferior ischemia.
We performed successful anaesthetic management of a patient with ischemic heart disease and low ejection fraction 22% who underwent percutaneous nephrolithotomy using epidural anaesthesia and analgesia.

Key words: Cardiac disease, low cardiac function, ischemic heart disease, Non-cardiac Surgery, Regional Anesthesia, Epidural anaesthesia

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