Graded epidural anesthesia for fistulectomy with symptomatic obstructive hypertrophic cardiomyopathy

Hemodynamic fluctuations can occur when fistulectomy is usually done under spinal anesthesia that can cause detrimental effects for a patient with obstructive cardiomyopathy. This is a case of 51-year-old male with fistula in ano sustaining obstructive hypertrophic cardiomyopathy as suggested by chest pain, palpitation, breathlessness on exertion was scheduled for fistulectomy. Electrocardiography (ECG) showed left ventricular hypertrophy with deep narrow Q waves in V1 to V6. Echo showed asymmetrical septal hypertrophy, grade 1 diastolic dysfunction, EF – 60%. Regional anesthesia technique such as graded epidural anesthesia can be safe and cost effective by prolonging the postoperative pain relief and thus also effective in blunting autonomic, somatic, and endocrine response triggered by surgical insult.