Effect of spinal-epidural anesthesia on brain natriuretic peptide (bnp) in patients with ischemic dilated cardiomyopathy undergoing peripheral vascular surgery

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 combined spinal epidural anesthesia (CSE). The primary end point was the effect of CSE on postoperative BNP and its predictability for the outcome, while the secondary outcome was the cardiac outcome over 6 months postoperatively. Results: CSE offers perioperative hemodynamic stability, and complication free early hospital stay, however it does not attenuate the rise of BNP. 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 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 cardiac patients undergoing peripheral vascular surgery.