Sequential Combined Spinal Epidural Anesthesia in Geriatric Patient with Unstable Angina Complicated with Left Ventricular Dysfunction for Non-cardiac Surgery

Q: What are the key findings of this study?

Sequential combined spinal-epidural anesthesia achieved a T6 sensory block and Bromage 3 motor block while maintaining hemodynamic stability throughout a 120-minute colostomy reversal in a patient with unstable angina and LVEF of 37%.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Unstable angina and left ventricular dysfunction undergoing non-cardiac surgery (n=1). Intervention: Sequential combined spinal-epidural anesthesia (CSEA). Primary outcome: Intraoperative hemodynamic stability and surgical anesthesia adequacy.

Q: What does this research mean for the field?

Sequential combined spinal-epidural anesthesia provides effective surgical anesthesia while maintaining intraoperative hemodynamic stability in high-risk geriatric patients with unstable angina and left ventricular dysfunction undergoing non-cardiac abdominal surgery. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Amira Salwa Abdullah

doi:10.37231/ajmb.2026.10.2.927

October 31, 2026Asian Journal of Medicine and BiomedicineOpen Access

Sequential Combined Spinal Epidural Anesthesia in Geriatric Patient with Unstable Angina Complicated with Left Ventricular Dysfunction for Non-cardiac Surgery

View Full Paper

Ask AI

Bookmark

Share

Key result

Sequential combined spinal-epidural anesthesia maintains hemodynamic stability during abdominal surgery in ischemic cardiomyopathy.

n=1

Why the study?

In high-risk cardiac patients undergoing non-cardiac surgery, general anesthesia poses a high risk of myocardial depression and hemodynamic instability, while conventional spinal anesthesia risks profound hypotension.

Key Points

To describe the anesthetic management and hemodynamic control achieved with sequential combined spinal-epidural anesthesia in a high-risk geriatric patient undergoing elective abdominal surgery.
Case report of a 63-year-old male with unstable angina, left ventricular dysfunction (ejection fraction 37%, NYHA Class III, ASA IV) presenting for elective reversal of a transverse colostomy.
Administered a low-dose subarachnoid block at L3–L4 using 1.0 mL of 0.5% hyperbaric bupivacaine (5 mg) with 25 µg of fentanyl, followed 10 minutes later by an epidural top-up of 6.0 mL of equal parts 0.75% ropivacaine and 2% lignocaine at L1–L2.
Maintained intraoperative arterial and central venous monitoring, light sedation with dexmedetomidine infusion (0.3 mcg/kg/hr), and minimal inotropic/vasopressor support with dobutamine and noradrenaline.
The sequential technique achieved a peak sensory block at the T6 dermatome 10 minutes after the epidural injection and complete lower-limb motor blockade (Bromage score of 3).
Hemodynamic stability was maintained across the 120-minute surgical procedure with minimal vasopressor support, without significant hypotensive episodes or ischemic electrocardiographic changes.
The patient required no intraoperative rescue analgesia and completed an uneventful postoperative recovery after transfer to the intensive care unit.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 63-year-old male with unstable angina, moderate left ventricular systolic dysfunction (LVEF 37%), NYHA Class III, and ASA Class IV undergoing a 120-minute elective reversal of a transverse colostomy.

I

Intervention

Sequential combined spinal-epidural anesthesia (CSEA): subarachnoid block at L3-L4 using 1.0 mL of 0.5% hyperbaric bupivacaine (5 mg) combined with 25 mcg of fentanyl, followed 10 minutes later by epidural incremental doses of 6.0 mL of an equal mixture of 0.75% ropivacaine and 2% lignocaine via an L1-L2 epidural catheter, accompanied by low-dose dobutamine and noradrenaline and a dexmedetomidine infusion at 0.3 mcg/kg/hr.

O

Outcome

Intraoperative hemodynamic stability, sensory/motor blockade adequacy (T6 sensory level, Bromage score 3), and uneventful postoperative recovery over the 120-minute surgery.safety

This case report illustrates that sequential combined spinal-epidural anesthesia can provide effective surgical anesthesia while maintaining hemodynamic stability in a high-risk patient with unstable angina and reduced left ventricular ejection fraction undergoing non-cardiac abdominal surgery.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support sequential CSEA in high-risk cardiac patients; hypothesis-generating and requires prospective trials before adoption.

Abstract

Sequential combined spinal-epidural anesthesia (CSEA) is a regional anesthetic technique that allows for controlled hemodynamic modulation, making it a valuable option in high-risk patients undergoing non-cardiac surgery. We present a case of a geriatric patient with unstable angina and severe left ventricular (LV) dysfunction (ejection fraction <30%) who required elective reversal of a transverse colostomy surgery. General anesthesia posed a high risk of myocardial depression and hemodynamic instability, while conventional spinal anesthesia risked profound hypotension. A sequential CSEA was chosen to provide effective anesthesia with gradual sympathetic blockade, maintaining cardiovascular stability throughout the procedure. The patient remained hemodynamically stable intraoperatively with minimal vasopressor support and had an uneventful postoperative recovery. This case highlights the efficacy and safety of sequential CSEA as an anesthetic technique in patients with significant cardiac comorbidities where anesthetic goals include minimizing myocardial oxygen demand and maintaining hemodynamic balance.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Amira Salwa Abdullah (2026) conducted a case report in Unstable angina and left ventricular dysfunction undergoing non-cardiac surgery (n=1). Sequential combined spinal-epidural anesthesia (CSEA) was evaluated on Intraoperative hemodynamic stability and surgical anesthesia adequacy. Sequential combined spinal-epidural anesthesia achieved a T6 sensory block and Bromage 3 motor block while maintaining hemodynamic stability throughout a 120-minute colostomy reversal in a patient with unstable angina and LVEF of 37%.

synapsesocial.com/papers/6aea772189a8acbed9c87af7 https://doi.org/10.37231/ajmb.2026.10.2.927

View Full Paper

Ask AI

Bookmark

Share

Sequential Combined Spinal Epidural Anesthesia in Geriatric Patient with Unstable Angina Complicated with Left Ventricular Dysfunction for Non-cardiac Surgery

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sequential Combined Spinal Epidural Anesthesia in Geriatric Patient with Unstable Angina Complicated with Left Ventricular Dysfunction for Non-cardiac Surgery

Key Points

Study Design

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading