Continuous low dose segmental epidural anesthesia may be a safe alternative to general anesthesia for orthopedic surgery in patients with severe mitral stenosis, atrial fibrillation, and renal failure.
May support cautious use in select mitral stenosis cases; hypothesis-generating case report requiring prospective validation.
We present a case of elderly patient aged 65 years who is suffering with severe mitral stenosis associated with atrial fibrillation, pulmonary artery hypertension and renal failure posted for right subtrochanter DHS fixation under continuous low dose segmental epidural anesthesia. Atrial fibrillation, pulmonary artery hypertension and renal failure carry high morbidity and mortality during surgery. General anesthesia is associated with high morbidity and mortality in patients with severe mitral stenosis associated atrial fibrillation, pulmonary hypertension and renal failure. In order to avoid high mortality associated with general anesthesia, we opted for continuous low dose segmental epidural anesthesia, which provided excellent Intraoperative hemodynamic stability and postoperative analgesia. This case highlights the advantage of continuous low dose segmental epidural anesthesia over general anesthesia in patients with severe mitral stenosis with atrial fibrillation and renal failure.
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A et al. (2014) studied this question.
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