Mitra Manasij, Basu Maitraye, Shailendra Kumar, Jain Anil Chandra
Department of Anesthesiology, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India.
Department of Biochemistry, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India.
Anesth Essays Res. 2020 Apr-Jun;14(2):277-282. doi: 10.4103/aer.AER_48_20. Epub 2020 Oct 12.
Hypertrophic obstructive cardiomyopathy is a type of hypertrophic cardiomyopathy (HCM) that involves the left ventricular outflow tract obstruction. Most important parameters are preload, afterload, and ventricular contractility that are prone to fluctuations in HOCM patients in the perioperative period due to the surgical procedure, anesthetic agents and changes in intravascular volume. These lead to increased chances of arrhythmias and myocardial ischemia and can pose significant morbidity and mortality in HCM patients perioperatively. Here, we report three challenging cases of HCM with comorbidities who underwent successful operative management of lower limb fractures using regional nerve blocks. Although general anaesthesia is usually preferred in cases of HCM, this was not the preferred choice in these cases due to the asthmatic status, extremes of age, and also associated comorbidities such as chronic kidney disease Stage IV on maintenance hemodialysis. We selected Ultrasonography and peripheral nerve stimulator (PNS) guided regional nerve blocks including lumbar plexus and parasacral approach of sciatic nerve block in the first two patients and fascia iliaca compartment block with parasacral sciatic nerve block in the third case to successfully manage the patients perioperatively. Postoperative pain management was satisfactory. All the patients were discharged in a hemodynamically stable condition with advice for follow-up.
肥厚性梗阻性心肌病是肥厚型心肌病（HCM）的一种类型，涉及左心室流出道梗阻。最重要的参数是前负荷、后负荷和心室收缩力，在围手术期，由于手术操作、麻醉药物和血管内容量的变化，肥厚性梗阻性心肌病患者的这些参数容易波动。这些因素增加了心律失常和心肌缺血的几率，并且在围手术期可能给肥厚型心肌病患者带来显著的发病率和死亡率。在此，我们报告3例合并其他疾病的肥厚型心肌病患者，他们采用区域神经阻滞成功接受了下肢骨折手术治疗。虽然肥厚型心肌病患者通常首选全身麻醉，但由于哮喘状态、年龄过大以及合并其他疾病，如维持性血液透析的慢性肾脏病IV期，在这些病例中全身麻醉并非首选。在前两名患者中，我们选择超声和外周神经刺激器（PNS）引导的区域神经阻滞，包括腰丛阻滞和坐骨神经阻滞的骶旁入路，在第三例患者中选择髂筋膜间隙阻滞联合骶旁坐骨神经阻滞，以在围手术期成功治疗这些患者。术后疼痛管理效果满意。所有患者均在血流动力学稳定的状态下出院，并得到随访建议。
