Successful Use of Ultrasound Guided Quadratus Lumborum Block Without General Anesthesia for Open Appendectomy in a Patient with Heart Failure with Reduced Ejection Fraction- A Case Report and Literature Review.

IF 1.5 Q3 ANESTHESIOLOGY Local and Regional Anesthesia Pub Date : 2024-02-23 eCollection Date: 2024-01-01 DOI:10.2147/LRA.S438176
Muhammad Jaffar Khan, Yasir Eltayeb, Arunabha Karmakar, Rohma Malik, Tarig Elsafi
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Abstract

Background: Patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) are at high risk of perioperative cardiovascular complications. While it is important to focus on optimizing their cardiac function, it is also crucial to address and optimize any other modifiable risk factors that could potentially impact postoperative outcome. This also includes careful consideration of anesthetic techniques to suit the patient and facilitate the surgery. However, there is a scarcity of evidence regarding the safety of specific anesthetic approaches for heart failure patients.

Case presentation: We describe the case of an adult patient in mid-50s, with a history of ischemic dilated cardiomyopathy with reduced Ejection Fraction (about 25%) who presented with acute gangrenous appendicitis and was scheduled for an open appendectomy. It was deemed to be a high-risk patient for general and spinal anesthesia. With the guidance of a multidisciplinary team, surgery was successfully performed using a quadratus lumborum block with standard monitoring. The patient was comfortable and hemodynamically stable throughout the procedure. The postoperative course was uneventful.

Conclusion: Quadratus Lumborum Block for open appendectomy can be a beneficial alternative anesthesia technique in high-risk patients that significantly lowers perioperative cardiovascular risk, maintains hemodynamics, enhances satisfaction, and shortens hospital stay.

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超声引导下腰椎四头肌阻滞在无全身麻醉情况下成功用于射血分数降低型心力衰竭患者的开腹阑尾切除术--病例报告和文献综述。
背景:被诊断为射血分数降低性心力衰竭(HFrEF)的患者围手术期心血管并发症风险很高。重点优化其心脏功能固然重要,但解决和优化可能影响术后效果的任何其他可改变的风险因素也至关重要。这还包括仔细考虑麻醉技术,以适合患者并促进手术。然而,有关心衰患者特定麻醉方法安全性的证据却很少:我们描述了一例 50 多岁的成年患者的病例,该患者有缺血性扩张型心肌病史,射血分数降低(约 25%),因急性坏疽性阑尾炎而被安排进行开腹阑尾切除术。该患者被认为是全身麻醉和脊髓麻醉的高风险患者。在多学科团队的指导下,手术在标准监测下通过腰椎四头肌阻滞成功实施。在整个手术过程中,患者感觉舒适,血流动力学稳定。术后恢复顺利:腰椎四头肌阻滞用于开放式阑尾切除术是一种有益的替代麻醉技术,适用于高风险患者,可显著降低围术期心血管风险、维持血流动力学、提高满意度并缩短住院时间。
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来源期刊
CiteScore
6.30
自引率
0.00%
发文量
12
审稿时长
16 weeks
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