Safe Surgery for the Heart at Risk Anaesthetic Management in Elderly Cardiac Patients Undergoing Hernia Repair

Introduction

Managing anaesthesia in elderly patients with pre-existing cardiac conditions poses unique challenges, especially during non-cardiac surgeries. A compelling case report highlights how tailored regional anaesthesia strategies can minimize risks and improve surgical outcomes for high-risk patients with ischaemic heart disease (IHD) and a history of myocardial infarction (MI).
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Case Summary: A High-Risk Patient Profile

A 70-year-old hypertensive male with a previous MI and stable diabetes presented for elective right inguinal hernia repair. Key clinical details include:

• History: Inferior wall MI (4 years prior), managed conservatively; on Metoprolol and Clopidogrel.
• Comorbidities: Hypertension, Type 2 Diabetes Mellitus.
• Functional capacity: NYHA class II, METs ≥ 4.
• Cardiac assessment: EF 40–45%, RCA territory akinesia, mild mitral regurgitation.

Anaesthetic Strategy and Intraoperative Management

The anaesthesia team opted for spinal anaesthesia over general anaesthesia due to its advantages in high-risk cardiac patients:

• Technique: Bupivacaine with fentanyl administered via subarachnoid block.
• Benefits:
  • Reduced preload and afterload
  • Better coronary perfusion
  • Reduced stress and coagulation responses
  • Minimized hemodynamic fluctuations
  • Superior postoperative analgesia

Pre-operative optimization included withholding antiplatelet and diabetic medications appropriately, and continuing ACE inhibitors and beta-blockers to maintain cardiovascular stability.

Read the full study at https://doi.org/10.29328/journal.ijcar.1001013

Clinical Outcomes and Recovery

• Intraoperative period: Stable vitals, no adverse events.
• Postoperative care: Oxygen via venti-mask, analgesia with paracetamol, early mobilization.
• Discharge: Patient was discharged uneventfully on the first postoperative day.

A detailed analysis can be found in our main journal article.

Broader Clinical Implications

The case underscores the significance of individualized anaesthetic plans in elderly patients with cardiac comorbidities.
The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend thorough perioperative risk assessment and stress the importance of maintaining myocardial oxygen balance to avoid ischemic complications in non-cardiac surgeries.
Additionally, the European Society of Anaesthesiology (ESA) advocates for neuraxial anaesthesia where appropriate, as it has been shown to reduce 30-day mortality and major complications in elderly cardiac patients.

Internal Insights and Related Resources

• Explore similar high-risk anaesthesia management cases under our Cardiac Anaesthesia category.
• Learn how spinal anaesthesia is revolutionizing non-cardiac surgeries for cardiac patients in our latest articles.

Don’t miss other cutting-edge anaesthetic innovations on our homepage.

Key Takeaways

• Patient Profile: Elderly, post-MI, hypertensive, diabetic male.
• Preferred Technique: Spinal anaesthesia minimized cardiac stress.
• Outcome: Stable intraoperative course and smooth recovery.
• Clinical Message: Regional anaesthesia, when properly planned, offers a safer alternative in patients with IHD undergoing lower abdominal surgeries.

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