Of course I would never do a spinal in AS patients. I’ve always wondered why the decreases SVR from GA is preferred to the decreased SVR from spinal….Great job practicing, but I wouldn't call anyone getting a TAVR a "subtle AS murmur"
Of course I would never do a spinal in AS patients. I’ve always wondered why the decreases SVR from GA is preferred to the decreased SVR from spinal….Great job practicing, but I wouldn't call anyone getting a TAVR a "subtle AS murmur"
Have done many spinals on patients with mild AS and never had a problem.Of course I would never do a spinal in AS patients. I’ve always wondered why the decreases SVR from GA is preferred to the decreased SVR from spinal….
I have never bought into it but spinal is not reversible whereas ga is “titrateable”Of course I would never do a spinal in AS patients. I’ve always wondered why the decreases SVR from GA is preferred to the decreased SVR from spinal….
Teach us.Lol this is a great question . What a breathtaking failure of critical thinking and lack of understanding.
Teach us.
Sure we understand this, but in most cases cardiomyopathy with LVEF 10% isn’t going to improve significantly with optimal medical management, unless the echo was take during acute heart failure from cardio genie shock for some reason. 10% EF is pretty much always going to mean severe heart failure.Well 10% is not 10%. Is it well compensated? Is it reduced and dilated? Is it acute or chronic? Is it due to loading conditions? The TTE is just a snapshot of one point in the patient's condition. We all know that patients are dynamic, especially under anesthesia and with the stress of surgical insult.
Sure we understand this, but in most cases cardiomyopathy with LVEF 10% isn’t going to improve significantly with optimal medical management, unless the echo was take during acute heart failure from cardio genie shock for some reason. 10% EF is pretty much always going to mean severe heart failure.
You almost definitely have, we all have and didnt know it.Of course I would never do a spinal in AS patients. I’ve always wondered why the decreases SVR from GA is preferred to the decreased SVR from spinal….
Sure we understand this, but in most cases cardiomyopathy with LVEF 10% isn’t going to improve significantly with optimal medical management, unless the echo was take during acute heart failure from cardio genie shock for some reason. 10% EF is pretty much always going to mean severe heart failure.
Sure, CRT has evidence that it improves EF and heart failure symptoms, but only if patient has a low EF and IVCD, even then the improvement is usually modest, yojr case is quite extraordinary. The dude with AF and cardiomyopathy isn’t going to get better.I have seen people who have gone from 15-20% to 40% with CRT.
Sure, CRT has evidence that it improves EF and heart failure symptoms, but only if patient has a low EF and IVCD, even then the improvement is usually modest, yojr case is quite extraordinary. The dude with AF and cardiomyopathy isn’t going to get better.
Anyone with low EF and CHF has seen a cardiologist and been assessed if CRT is indicated. In fact most will see their cardiologist for clearance before their elective surgery for a spinal block. Maybe hip fracture is the exception, but for the most part spinals are elective surgery. So I don’t usually ever see a situation where I can say “EF is low, but maybe it’ll get better after a dual chamber pacer is placed by the cardiologist before this surgery”. Also, the only population for CRT is low EF with an IVCD and clinical heart failure class 3 or 4 I beleive, not every low EF patient.Thought we are just talking about folks with low EF.
Great thing about EPIC is that it’s easy to find all the old echos. It’s not that rare.
In this study, highest quartile of patients had LVEF improve by 17%.
What is your cut off for spinals in patients with reduced EF? At what LVEF would you think general is a safer option than spinal for electric ortho cases?
Whether someone with HFrEF can tolerate a spinal is more complex and nuanced than just the "EF."
There are plenty of LVEF 20-25% pts who would do great with neuraxial and plenty of LVEF 35-40% pts who would crash and burn.
It'll be 20% once they lose some blood!! and 10% of 300cc ventricle is still 30ccs per beat.got a ef 10% add on today for fracture. reminded me of this thread ha!
Of course I would never do a spinal in AS patients. I’ve always wondered why the decreases SVR from GA is preferred to the decreased SVR from spinal….
That's absurd, plenty of people with a fib and cardiomyopathy get better after the tachycardia is controlled.Sure, CRT has evidence that it improves EF and heart failure symptoms, but only if patient has a low EF and IVCD, even then the improvement is usually modest, yojr case is quite extraordinary. The dude with AF and cardiomyopathy isn’t going to get better.