Is neuraxial blockade contraindicated in the patient with aortic stenosis?

McDonald, Susan B.

doi:10.1016/j.rapm.2004.06.010

Cited by 17 publications

(13 citation statements)

References 55 publications

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“…Although spinal anaesthesia is not absolutely contraindicated for patients with aortic stenosis [15], these patients are more susceptible to the potential hazard of sudden hypotension as a result of the reduced systemic vascular resistance caused by sympathetic blockade from spinal anaesthesia precipitating a vicious circle of reduced coronary perfusion, impaired ventricular function secondary to myocardial ischaemia, and worsening hypotension that may fail to respond to vasopressor treatment if not implemented rapidly. No randomised studies have been performed to compare general vs spinal anaesthesia in patients with aortic stenosis undergoing non‐cardiac surgery, and it is unlikely that one will ever be performed.…”

Section: Discussionmentioning

confidence: 99%

Previously undiagnosed aortic stenosis revealed by auscultation in the hip fracture population – echocardiographic findings, management and outcome

McBrien¹,

Heyburn²,

Stevenson

et al. 2009

Anaesthesia

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Summary The 2001 Report of the National Confidential Enquiry into Perioperative Deaths recommended that an echocardiogram should be performed on patients with aortic stenosis prior to anaesthesia. In this study we present the patient details, management and outcome of the 272 hip fracture patients with a previously undiagnosed murmur and echocardiographically proven aortic stenosis admitted from 2001–2005 in our hospital. The patients with aortic stenosis were significantly older, and had significantly lower Abbreviated Mental Test Scores, than the control group of 3698 hip fracture patients without aortic stenosis. There were significant trends toward general anaesthesia over spinal anaesthesia, and use of invasive monitoring of blood pressure, as the severity of the aortic stenosis increased. There were no significant trends towards higher 30‐day or 1‐year mortality rates as the severity of the aortic stenosis increased. Resources for rapid pre‐operative echocardiograms should be made available for hip fracture patients as the results have significant implications for their subsequent anaesthetic management.

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Section: Discussionmentioning

confidence: 99%

Previously undiagnosed aortic stenosis revealed by auscultation in the hip fracture population – echocardiographic findings, management and outcome

McBrien¹,

Heyburn²,

Stevenson

et al. 2009

Anaesthesia

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“…The use of neuraxial block in the patient with clinically significant cardiac disease is a controversial issue because of possible cardiovascular fluctuation with blockade of the autonomic system. [101112] Historically, anesthesiologists have avoided regional anesthesia in the parturient with cardiovascular disease because of the adverse cardiovascular changes in a patient with a fixed cardiac output. Hypotensionin these patients can produce myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Combined mitral and aortic stenosis in parturient: Anesthesia management for labor and delivery

Kela

Buddhi

2017

J Anaesthesiol Clin Pharmacol

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Maternal heart disease complicates 0.2-3% of pregnancies. The optimal management of the pregnant patient with cardiac disease depends on the co-operative efforts of the obstetrician, the cardiologist and the anesthesiologist involved in peripartum care. A comprehensive understanding of physiology of pregnancy and pathophysiology of underlying cardiac disease is of primary importance in provision of obstetric analgesia or anesthesia for these high-risk groups of patients.We report a successful and uncomplicated use of epidural anesthesia for labor and delivery in patient with combined aortic and mitral stenosis.

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“…The Brazilian survey reports a cardiac arrest in a patient with mixed mitral valve disease after a spinal, for example [3]. Moreover, there are reports of patients with significant aortic stenosis undergoing successful neuraxial anaesthesia [10].…”

Section: Cardiopulmonary Collapsementioning

confidence: 99%