Unexplored role of hypobaric spinal anesthesia in cardiac patients with low ejection fraction: A case series

Anesthetic management of cardiac patients with low ejection fraction (EF) on two-dimensional echocardiography is a challenge. Underlying cardiac condition, type and duration of surgery and overall optimization of the patient determine the plan of anesthesia in these patients. Hypobaric spinal anesthesia (SA) known for its role in anorectal procedures was found to be a suitable tool in the management of cardiac patients with low EF who underwent infraumbilical surgeries in our case series. Hypobaric SA with 0.1% bupivacaine and fentanyl as an adjuvant gave a satisfactory outcome without significant hemodynamic changes with its differential blockade nature. We found it to be a simpler, safer, economical, and efficient technique which lasted for an average duration of 2½ hours, although it is a rarely practiced technique. We conclude that the practice of hypobaric SA can be considered one of the options in the anesthetic management of infraumbilical superficial surgeries of moderate duration in cardiac patients with low EF.