Background :Neuroaxial anesthesia for patients with cardiac disease is still a matter of debate . BNP has been added as a cardiac biomarker in response to stress. Spinal-epidural anesthesia seems to full fill some criteria of therapeutic intervention in cardiac patients. For this , in a group of patients with impaired left ventricular function , we test whether epidural –spinal anesthesia has an effect on BNP as well as testing the predictability of postoperative BNP for outcome.
Methods : the authors conducted this study on 24 lower extremity vascular surgery patients with ischemic dilated cardiomyopathy ( EF <40 % ) under CSE .the primary end point was the cardiac outcome over 6 months postoperatively, the secondary outcome was the effect of CSE on postoperative BNP and its predictability for the outcome .
Results : CSE offers perioperative hemodynamic stability ,and complication free early hospital stay period , but mortality and morbidity rates were 8% and 41.6 % respectively over the next 6 months . postoperative BNP ≥67.43pg/ml , provided the optimal BNP cutoff points for predicting major cardiac complications
In conclusion, CSE is a feasible technique of anesthesia in such patients with dilated cardiomyopathy undergoing vascular surgery in the lower half of the body . BNP study revealed that postoperative BNP levels are valuable bed side predictors of intermediate term post-operative cardiac death and major adverse cardiac events in