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The Anesthetic Management of a Patient With Advanced Heart Failure Undergoing Non-cardiac Surgery

Year: 2026

Type: article

Abstract: Severe heart failure (HF) is associated with high perioperative morbidity and mortality during non-cardiac surgery. Anesthetic management for patients with critically reduced left ventricular ejection fraction (LVEF) requires strategies that minimize myocardial depression and autonomic instability. We present the case of a 73-year-old male with severe HF (LVEF 18%), a permanent pacemaker, severe anemia, and ongoing clopidogrel therapy who required urgent fixation of an open distal humerus fracture. General anesthesia was considered prohibitively high risk. An ultrasound-guided supraclavicular brachial plexus block was performed using 20 mL of 0.5% ropivacaine. Surgery proceeded uneventfully without hemodynamic instability, and the patient was discharged from the ICU after 24 hours. Regional anesthesia provides significant hemodynamic advantages in high-risk cardiac patients. Ultrasound guidance allows for precise needle placement and may reduce complications, even in patients receiving antiplatelet therapy, when the benefits outweigh the risks. An ultrasound-guided supraclavicular block proved to be a safe and effective anesthetic strategy in a patient with severe HF undergoing emergency orthopedic surgery.

Source: Cureus

DOI: 10.7759/cureus.103869

Authors: Renata G Falchetti, Ivandete C Pereira Pimentel, Luísa C Alves Ribeiro de Castro, Almir A Pimentel Jr

Institution: Universidade do Sul de Santa Catarina

Language: English

Topic: Cardiac, Anesthesia and Surgical Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7130345990