Epidural Anesthesia in Ureterolithiasis Patient with Cardiovascular Diseases: A Case Report

Abstract

The number of surgical procedures in patients with cardiovascular comorbidities has increased in recent decades. Regional anesthetic procedures, either unaccompanied or combined with general anesthesia, are useful perioperatively for reducing the stress response and cardiac sympathetic activity, enabling earlier extubation, shortening hospital stay, and providing good postoperative analgesia. This case report aims to provide insight into the appropriate selection of anesthesia in a patient with comorbid heart failure and chronic renal failure. Anesthetic techniques in patients with cardiovascular disorders require a good understanding of physiology and pharmacology. In this case, a regional anesthetic technique was chosen because it offers several advantages for patients with cardiovascular comorbidities. A 69-year-old man was diagnosed with right ureterolithiasis with severe right hydronephrosis and end stage chronic kidney disease (CKD), as well as chronic heart failure (CHF) functional class II and mild mitral regurgitation (MR). He underwent ureterolithotomy in the supine position. Epidural anesthesia (bupivacaine 0.375%) was associated with hemodynamic fluctuations, with blood pressure of 92–131/57–80 mmHg, heart rate of 62–88 beats/min, respiratory rate of 16–18 breaths/min, and SpO2 of 98–99% with oxygen via nasal cannula. During the operation, the patient was quite comfortable, and no additional pain medication was administered. Postoperatively, epidural bupivacaine 0.0625% with morphine 0.5 mg was administered for analgesia. In conclusion, epidural anesthesia is suggested in selected patient with chronic renal failure and heart disease, which provided favorable results, without major perioperative complications, and reduced postoperative pain.

Keywords: Cardiovascular disease, epidural anesthesia, geriatric, renal failure