Epidural anaesthesia for abdominal surgery in a 72-year-old with dilated cardiomyopathy: a case report

A 72-year-old female, retired trader, receiving multidisciplinary care for dilated cardiomyopathy and congestive cardiac failure, with massive cardiomegaly, endomyocardial fibrosis, pericardial effusion, atrial fibrillation, ascites and umbilical hernia was scheduled for elective herniorrhaphy at the University of Port Harcourt Teaching Hospital (UPTH). She successfully had surgery under lumbar epidural anaesthesia achieved with morphine, ketamine and low dose bupivacaine combination, and was eventually discharged home postoperatively after satisfactory recovery. The anaesthetic challenges posed by the presence of multiple grave cardiovascular pathologies in association with dilated cardiomyopathy and the critical significance of judicious epidural anaesthetic technique in the successful management of this patient are highlighted.