Why the study?
Recent inferior STEMI and PCI in an elderly patient scheduled for bilateral lower extremity operations represent significant risks for re-infarction and mortality.
Does spinal injection of ultra-low-dose isobaric bupivacaine with morphine and fentanyl provide adequate anesthesia and hemodynamic stability in an elderly patient with recent MI and PCI undergoing bilateral lower extremity operations?
Does spinal injection of ultra-low-dose isobaric bupivacaine with morphine and fentanyl provide adequate anesthesia and hemodynamic stability in an elderly patient with recent MI and PCI undergoing bilateral lower extremity operations?
Ultra-low-dose isobaric bupivacaine with intrathecal opioids may provide safe and effective spinal anesthesia with hemodynamic stability in high-risk geriatric patients with recent myocardial infarction.
Answers are grounded in this paper and cite their sources.
May support ultra-low-dose spinal anesthesia in recent-MI patients; hypothesis-generating and requires prospective validation before practice change.
A recent inferior ST-elevation myocardial infarction and percutaneous coronary intervention in an elderly female patient scheduled for bilateral lower extremity operations simultaneously represent significant risks for re-infarction and mortality. Our index patient required an above-knee amputation of the left leg to prevent infection/progressing gangrene as well as application of a back-slab for the conservative management of a fractured right femur. We employed spinal injection of ultra-low-dose 0.5% isobaric bupivacaine 4 mg with morphine 75 mcg plus fentanyl 10 mcg which provided adequate anesthesia for radical amputation, effective postoperative analgesia and good hemodynamic stability.
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Rukewe et al. (2021) studied this question.
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