ANAESTHETIC MANAGEMENT OF A PATIENT WITH CCF POSTED FOR ELECTIVE ANKLE ARTHRODESIS

Introduction: Patients with low ejection fraction and congestive cardiac failure (CCF) are at an increased risk of signicant perioperative cardiac complications and mortality. The primary objective in managing such patients during surgery is to ensure hemodynamic stability. A 65 year old male patient came wit Case Report: h the history of trauma over the left foot followed by a non healing ulcer associated with intermittent pain and non purulent serosanguinous discharge from the ulcer. He was a known case of type 2 diabetes mellitus since 9 years on Glimepiride 2mg BD and a known case of CAD/Congestive cardiac failure on Aspirin, statin, diuretics and beta blockers. On examination , vitals were stable , bilateral grade 1 pitting pedal edema was noted. Also bilateral basal crepitations were present.The patient was posted for elective ankle arthrodesis under selective spinal anesthesia. Patient was taken up for surgery under ASA3,NYHA class 3 CHF , METS <4 after , obtaining high risk consent. Under all aseptic precautions ,subarachnoid block was given with patient in left lateral position , in L3-L4 interspace using 27G Quincke spinal needle , with a mixture of Ropivacaine 0.75%(H) 1ML and Morphine 100mcg(1ml).Patient remained in the lateral position for 15minutes following which was positioned supine for surgery. Intraop and postop were uneventful.Patient was pain free for 6hrs postop Selective spinal CONCLUSION : anaesthesia can be a useful alternative anesthetic technique in patients with low output heart failure undergoing lower limb surgeries.