Ravishankar R.B.1, Vidya N.T.2
The incidence of ischemic heart disease (IHD) is increasing and it is the leading
cause of morbidity and mortality worldwide.1 These patients have increased risk
of myocardial ischemia, myocardial infarction (MI), conduction disturbances and
cardiac arrest perioperatively. Preoperative cardiovascular assessment and
prediction of short- and long-term risks affects the perioperative anaesthetic
management and also surgical decision making. Risk factors include recent MI,
congestive cardiac failure, peripheral vascular disease, angina pectoris, diabetes
mellitus (DM), hypertension, renal dysfunction, age, obesity and sedentary
lifestyle.2
The choice of anaesthesia is general anaesthesia so that myocardial oxygen
supply can be kept greater than demand by preventing tachycardia and high blood
pressures, which can lead to ischemia.3 Few studies have shown that Epidural
anaesthesia can decrease cardiac morbidity and mortality in IHD patients. We
report a successful anaesthetic management of IHD with ejection fraction of 30 %
posted for fracture femur surgery under Combined Spinal Epidural (CSE)
anaesthesia.
