Graded Epidural Anaesthesia as a Sole Anaesthetic Technique for Lower Limb Surgeries in Patients with Low Ejection Fraction: A Case Series

In patients with a history of ischemic heart disease with low ejection fraction, it’s always a challenge for the Anaesthesiologist to make a decision on whether to administer General Anaesthesia (GA), central neuraxial blockade, or both. When the Left ventricular ejection fraction (LVEF) percentage reduces to less than 35%, it indicates the presence of severe systolic dysfunction. Both general anaesthesia and regional anaesthesia carry potential risks due to these patients' low cardiac output status. Hemodynamic fluctuations associated with anaesthesia can be detrimental in these patients. A clear intraoperative plan should be designed to manage the hemodynamics of these patients. Here we report two cases of ischemic heart disease with low ejection fraction posted for orthopedic surgeries. Graded epidural anaesthesia was used as a sole anaesthetic technique. The patients were hemodynamically stable in the intraoperative as well as postoperative period. Keywords: Ischemic heart disease, Low Left Ventricular Ejection Fraction, Graded Epidural Anaesthesia, Cemented modular hemiarthroplasty, PFNA2.