engleski

The use of an ultrasound-guided supraclavicular brachial plexus block in a high risk patient with cardiomyopathy

With the rapid growth of the elderly population, along with increased comorbidities and greater life expectancy, geriatric surgery has become more frequent and requires careful tailoring of anesthesia technique. Preanesthetic evaluation should concentrate on the identification of age-related diseases and an estimation of physiological reserve. Age- related cardiovascular changes are leading factors impacting perioperative outcomes among elderly patients. The management of a patient with dilated cardiomyopathy, who undergoes a non-cardiac surgery, is always a challenge for an anesthesiologist, as this situation is associated with a high mortality rate. We report a use of the ultrasound guided supraclavicular brachial plexus block in 87- year old woman for revision of wound of left wrist and reposition and immobilization of left forearm and elbow. Her previous medical records revealed that she was a known case of arterial hypertension, chronic atrial fibrillation with dilated cardiomyopathy and chronic kidney disease, stage II. Postoperatively, she developed respiratory insufficiency. This case report exemplifies how despite all the measures and precaution we had taken, with choosing anesthesia with which we aimed and achieved having only minimal hemodynamic fluctuations and carefully planned and balanced hydration of patient we still had unwanted negative outcome.

ultrasound guided supraclavicular block, congestive heart failure

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