DELIBERATE HYPOTENSIVE EPIDURAL-ANESTHESIA FOR PATIENTS WITH NORMAL AND LOW CARDIAC-OUTPUT

The use of hypotensive anesthesia is contraindicated in patients with ventricular dysfunction, even though afterload reduction often improve s ventricular performance. The purpose of this study was to prospectiv ely assess systemic hemodynamic responses to deliberate hypotension wi th epidural anesthesia in patients with chronic left ventricular dysfu nction. Hemodynamic measurements were performed in 29 patients undergo ing total hip arthroplasty under deliberate hypotensive epidural anest hesia using low-dose intravenous epinephrine infusion to maintain mean arterial pressure (MAP) at 50-60 mm Hg. Intraoperative MAP decreased from 100 +/- 16 to 56 +/- 9 mm Hg by 30 min after epidural injection ( P < 0.0005). Concurrently, cardiac index (CI) increased from a preanes thetic baseline value of 2.9 +/- 0.5 to 3.3 +/- 0.9 L min(-1) m(-2) at 30 min (P < 0.005) after epidural injection and stroke volume index ( SVI) increased from 41 +/- 8 to 50 +/- 14 mL.beat(-1).m(-2) 30 min aft er epidural injection (P < 0.005). Heart rate and central venous and p ulmonary artery diastolic pressures were maintained under hypotension with epidural anesthesia in all patients. During deliberate hypotensio n with epidural anesthesia, patients with a history of congestive hear t failure or low preanesthetic CI (less than or equal to 2.5 L kg(-1) m(-2)) increased their CI and SVI into the normal range. There were no significant perioperative complications in either of these groups. Hy potensive epidural anesthesia can be used successfully in patients wit h low cardiac output from ventricular dysfunction undergoing total hip arthroplasty.