Low Dosage Regional Anesthesia for Bladder Tumors in Aortic Stenosis Patient

Abstract

Background: Aortic stenosis (AS) is a narrowing of the aortic valve. The most common cause of AS in adults is degenerative calcification of the aortic valve, which increases with age. ^1,2 Most patients with AS experience gradually increasing obstruction over years and will remain asymptomatic until the 6th to 8th decade of life, the prognosis will be poor when symptoms appear. Patients with aortic stenosis represent a hemodynamic challenge for anesthesiologists. The use of regional anesthesia in patients with severe aortic stenosis is contraindicated due to its sympatholytic effects which cause loss of vascular tone and a significant reduction in cardiac output.

Case: A 77 years old male with a height of 155 cm and a weight of 35 kg with moderate aortic stenosis (EF 65%), VHD, HHD HF with therapy, underwent bladder tumor surgery with low dose regional anesthesia using Bupivacaine 0.5% heavy 7.5 mg (1.5 ml) with adjuvant fentanyl 25 mcg with total volume 2 ml regional block was achieved within 5 minutes and hemodynamically stable perioperatively. There was no acute heart failure or worsening of postoperative hemodynamics.

Discussion: The main principle of anesthesia in aortic stenosis patient is to avoid tachycardia, maintain sinus rhythm and avoid a decrease in SVR which will cause compensation in the form of an increase in heart rate, thereby making the heart work harder, avoiding hypovolemia and fluid overload.

Conclusion: In this patient, low dose regional anesthesia can be used as an alternative to anesthesia in patients with aortic stenosis because of the stable hemodynamic compared to conventional regional anesthesia.