Intrathecal Hyperbaric Ropivacaine In Patients with Mild and Moderate IHD – Is It Safe? A Case Series

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Yasha.V. Kameshwar, Govind shaji, V Satyaprabhu, S. Parthasarathy


Spinal anaesthesia with hyperbaric Ropivacaine has been conducted for various surgeries including Cesarean section over past two decades. The convenience offered by this drug for delivering safe peri operative outcome in patients with Ischemic Heart Disease (IHD) for conduct of elective surgical procedures is worth considering due to the high burden of patients with IHD in our country, we present a case series of successful management of such cases. In Case 1, the patient underwent knee arthroscopy with stable hemodynamics throughout the surgery, with <10% variation in his vitals. This suggests that spinal anesthesia with hyperbaric Ropivacaine can provide safe perioperative outcomes in IHD patients undergoing elective surgeries. It is also noteworthy that the patient received only one dose of i.v Injection Mephentermine during the surgery, indicating minimal requirement for vasopressor support.In Case 2, the patient underwent haemorrhoidectomy under spinal anesthesia with stable hemodynamics and only two litres of oxygen through Hudson mask. This case highlights the importance of discontinuing dual antiplatelets prior to surgery to minimize bleeding complications.In Case 3, the patient underwent skin grafting for a non-healing ulcer over the dorsum of the right foot under spinal anesthesia with hyperbaric Ropivacaine. The patient maintained stable vitals throughout the surgery, even with the use of a tourniquet around the left thigh to obtain the skin graft.These cases demonstrate the feasibility and safety of spinal anesthesia with hyperbaric Ropivacaine in IHD patients undergoing elective surgeries. However, it is important to note that each patient's individual condition and medical history should be thoroughly evaluated before deciding on the anesthetic technique to be used. Close monitoring and appropriate management of any hemodynamic changes or complications should also be ensured.

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