This resource is a simulation scenario originating from a case experienced in the operating room. In this scenario, an 80-year-old male, who had a cardiac transplant 13 years prior, undergoes a spinal anesthetic for a wide local excision of Merkel cell carcinoma in his right thigh and thereafter develops refractory hypotension and subsequent myocardial ischemia. Sympathectomy and hypotension are well-known complications of a subarachnoid block. Identification and treatment of these common occurrences are considered basic principles in the use of neuraxial blocks. In a patient with a transplanted heart, the physiology involved can be further complicated as patients are preload dependent. This scenario exposes participants to the extreme complications of a subarachnoid block (hypotension and myocardial ischemia) in a patient with a cardiac transplant, as well as to the complicated responses to different treatments.
By the end of this resource, learners will be able to:
- Identify sympathectomy as the cause of hypotension immediately following subarachnoid block.
- Discuss the diagnosis and treatment of myocardial ischemia.
- Describe the appropriate selection of medications in a cardiac transplant patient experiencing severe refractory intraoperative hypotension.
- Demonstrate effective communication with operating room staff during a crisis and delegate tasks effectively.
- List the differential diagnosis of intraoperative hypotension.
- Describe the physiology of a patient with a transplanted heart and the effect of a subarachnoid block.
- Describe the preoperative evaluation of a patient with a transplanted heart.
© 2011 Chun et al.
This is an open-access article publication under the terms of the Creative Commons Attribution-No Derivatives license.
Chun D, Gavazza P, Hollister C, Canales C, Lin S. Simulation scenario- myocardial ischemia in a patient with a cardiac transplant after subarachnoid block. MedEdPORTAL. 2011;7:9029. https:/
doi. org/ 10. 15766/ mep_ 2374- 8265. 9029