Combined spinal-epidural anesthesia may be a safe and efficient alternative to general anesthesia for patients with severe aortic stenosis undergoing spinal surgeries in the prone position.
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May support neuraxial anesthesia consideration in select severe aortic stenosis cases; hypothesis-generating and should not change practice.
The use of neuraxial anesthesia has traditionally been contraindicated in patients with severe aortic stenosis. However, general anesthesia can be riskier than neuraxial anesthesia for severe aortic stenosis patients undergoing spinal surgeries in the prone position as this can cause a major reduction in cardiac output secondary to diminished preload. In addition, general anesthesia, muscle relaxation, and positive-pressure ventilation can decrease venous return and reduce vascular tone, further compromising cardiac output. Combined spinal-epidural anesthesia with closely monitored, careful titration of the local anesthetic dose can be an efficient and safe anesthetic method for managing such patients. We describe the successful management of combined spinal-epidural anesthesia in an asymptomatic severe aortic stenosis patient scheduled for lumbar discectomy.
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Kim et al. (2014) studied this question.
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