Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report
Abstract Background Total knee replacement is a major orthopedic procedure for severe, painful, and mobility-limiting knee arthritis. Aortic valve stenosis is the most frequent valvular heart disease and the most commonly performed valvular procedure. Stenosis of the valve may lead to left ventricul...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-08-01
|
| Series: | Ain Shams Journal of Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42077-023-00357-z |
| _version_ | 1797736425178791936 |
|---|---|
| author | Ajibade Okeyemi Akinola Akinmade Aliyu Zakari Suleiman Adeagbo Liasu Ahmed Bamidele Samuel Fayose Akande Adekunle Olabode |
| author_facet | Ajibade Okeyemi Akinola Akinmade Aliyu Zakari Suleiman Adeagbo Liasu Ahmed Bamidele Samuel Fayose Akande Adekunle Olabode |
| author_sort | Ajibade Okeyemi |
| collection | DOAJ |
| description | Abstract Background Total knee replacement is a major orthopedic procedure for severe, painful, and mobility-limiting knee arthritis. Aortic valve stenosis is the most frequent valvular heart disease and the most commonly performed valvular procedure. Stenosis of the valve may lead to left ventricular hypertrophy, ventricular dysfunction, myocardial ischemia, and a state of fixed cardiac output. Changes in hemodynamic parameters such as hypotension and bradycardia in patients with carotid artery stenosis may lead to cerebrovascular accidents, especially during anesthesia. Case presentation A 76-year-old woman with a 6-year history of bilateral knee pain. The pain was dull, aching, and severe in intensity, and it prevented her from sleeping despite optimal analgesics. A general physical examination revealed an elderly, frail woman in mild respiratory distress. She had bilateral small-volume radial pulses, positive hepatojugular reflux, and heart sounds of S1, S2, and S4 with an ejection systolic murmur, and carotid bruits were heard bilaterally. Epidural anesthesia was done by injection of 2.5 mL of 0.5% plain bupivacaine in aliquots every 5 min until the level of the block reached the suprapubic region (titrated segmental epidural anesthesia). The patient was not preloaded with intravenous fluid prior to the establishment of epidural anesthesia, and the epidural anesthesia-induced hypotension that may ensue was managed with intraoperative dopamine infusion at 5 µg/kg/min. Conclusions Titrated segmental epidural anesthesia with intraoperative infusion of low-dose dopamine reduces the perioperative risk of myocardial infarction, cerebrovascular accident, and neurocognitive deficit in a patient with severe aortic stenosis and severe bilateral carotid stenosis. |
| first_indexed | 2024-03-12T13:13:40Z |
| format | Article |
| id | doaj.art-a4202b495a2143908156ebeaf90c55d2 |
| institution | Directory Open Access Journal |
| issn | 2090-925X |
| language | English |
| last_indexed | 2024-03-12T13:13:40Z |
| publishDate | 2023-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Ain Shams Journal of Anesthesiology |
| spelling | doaj.art-a4202b495a2143908156ebeaf90c55d22023-08-27T11:09:50ZengSpringerOpenAin Shams Journal of Anesthesiology2090-925X2023-08-011511510.1186/s42077-023-00357-zTitrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case reportAjibade Okeyemi0Akinola Akinmade1Aliyu Zakari Suleiman2Adeagbo Liasu Ahmed3Bamidele Samuel Fayose4Akande Adekunle Olabode5Anaesthesia and Intensive Care Unit, Federal Medical CentreOrthopaedic and Trauma, Afe Babalola University Teaching HospitalUniversity of Ilorin Teaching HospitalFamily Medicine, Federal Medical Centre OwoOrthopaedic and Trauma, Afe Babalola University Teaching HospitalAnaesthesia Department, Afe Babalola University Teaching HospitalAbstract Background Total knee replacement is a major orthopedic procedure for severe, painful, and mobility-limiting knee arthritis. Aortic valve stenosis is the most frequent valvular heart disease and the most commonly performed valvular procedure. Stenosis of the valve may lead to left ventricular hypertrophy, ventricular dysfunction, myocardial ischemia, and a state of fixed cardiac output. Changes in hemodynamic parameters such as hypotension and bradycardia in patients with carotid artery stenosis may lead to cerebrovascular accidents, especially during anesthesia. Case presentation A 76-year-old woman with a 6-year history of bilateral knee pain. The pain was dull, aching, and severe in intensity, and it prevented her from sleeping despite optimal analgesics. A general physical examination revealed an elderly, frail woman in mild respiratory distress. She had bilateral small-volume radial pulses, positive hepatojugular reflux, and heart sounds of S1, S2, and S4 with an ejection systolic murmur, and carotid bruits were heard bilaterally. Epidural anesthesia was done by injection of 2.5 mL of 0.5% plain bupivacaine in aliquots every 5 min until the level of the block reached the suprapubic region (titrated segmental epidural anesthesia). The patient was not preloaded with intravenous fluid prior to the establishment of epidural anesthesia, and the epidural anesthesia-induced hypotension that may ensue was managed with intraoperative dopamine infusion at 5 µg/kg/min. Conclusions Titrated segmental epidural anesthesia with intraoperative infusion of low-dose dopamine reduces the perioperative risk of myocardial infarction, cerebrovascular accident, and neurocognitive deficit in a patient with severe aortic stenosis and severe bilateral carotid stenosis.https://doi.org/10.1186/s42077-023-00357-zAorticCarotidStenosisTitratedSegmentalEpidural |
| spellingShingle | Ajibade Okeyemi Akinola Akinmade Aliyu Zakari Suleiman Adeagbo Liasu Ahmed Bamidele Samuel Fayose Akande Adekunle Olabode Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report Ain Shams Journal of Anesthesiology Aortic Carotid Stenosis Titrated Segmental Epidural |
| title | Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report |
| title_full | Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report |
| title_fullStr | Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report |
| title_full_unstemmed | Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report |
| title_short | Titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis: a case report |
| title_sort | titrated segmental epidural anesthesia for bilateral total knee replacement in a patient with severe aortic stenosis and severe bilateral carotid artery stenosis a case report |
| topic | Aortic Carotid Stenosis Titrated Segmental Epidural |
| url | https://doi.org/10.1186/s42077-023-00357-z |
| work_keys_str_mv | AT ajibadeokeyemi titratedsegmentalepiduralanesthesiaforbilateraltotalkneereplacementinapatientwithsevereaorticstenosisandseverebilateralcarotidarterystenosisacasereport AT akinolaakinmade titratedsegmentalepiduralanesthesiaforbilateraltotalkneereplacementinapatientwithsevereaorticstenosisandseverebilateralcarotidarterystenosisacasereport AT aliyuzakarisuleiman titratedsegmentalepiduralanesthesiaforbilateraltotalkneereplacementinapatientwithsevereaorticstenosisandseverebilateralcarotidarterystenosisacasereport AT adeagboliasuahmed titratedsegmentalepiduralanesthesiaforbilateraltotalkneereplacementinapatientwithsevereaorticstenosisandseverebilateralcarotidarterystenosisacasereport AT bamidelesamuelfayose titratedsegmentalepiduralanesthesiaforbilateraltotalkneereplacementinapatientwithsevereaorticstenosisandseverebilateralcarotidarterystenosisacasereport AT akandeadekunleolabode titratedsegmentalepiduralanesthesiaforbilateraltotalkneereplacementinapatientwithsevereaorticstenosisandseverebilateralcarotidarterystenosisacasereport |