Continuous spinal anesthesia for TURBT in a morbidly obese patient with EF of 20%: a case report.

backgroundPatients with severely reduced left ventricular function pose major anesthetic challenges. General anesthesia may cause cardiac depression and pulmonary decompensation, while single-shot spinal anesthesia can trigger sudden hypotension. Continuous spinal anesthesia (CSA), however, allows gradual dosing and improved hemodynamic stability in such high-risk patients. CASE PRESENTATION: We report a 133-kg man with atrial fibrillation, left bundle branch block, global hypokinesia, ejection fraction (EF) of 20%, and prior pulmonary tuberculosis with lung congestion, who underwent transurethral resection of a bladder tumor (TURBT) under CSA. Using the epidural loss-of-resistance technique at L4-L5, a catheter was advanced to 12 cm (6 cm intrathecal). Incremental doses of 1 mg isobaric bupivacaine were administered every 15 minutes to a total of 5 mg. Noninvasive blood pressure was monitored every minute. Baseline BP was 154/98 mmHg and remained stable at 135/90 mmHg intraoperatively, with a heart rate of 65-75 bpm. Adequate anesthesia was achieved without vasopressor use, and recovery was uneventful (Table 1).

conclusionIncremental CSA with isobaric bupivacaine was safely and effectively used in a morbidly obese patient with low EF undergoing TURBT. The technique maintained hemodynamic stability throughout, suggesting CSA as a viable anesthetic option for endoscopic urologic procedures in patients with compromised cardiac function.