Abstract
There is a high probability of hemodynamic fluctuations to occur when fistulectomy done under spinal anesthesia among patients with obstructive cardiomyopathy. This is a case of 51-year-old male with fistula-in-ano and obstructive hypertrophic cardiomyopathy as suggested by chest pain, palpitation, and breathlessness on exertion. Electrocardiography (ECG) showed left ventricular hypertrophy with deep narrow Q waves in V1 to V6. Echo showed asymmetrical septal hypertrophy, grade 1 diastolic dysfunction with ejection fraction of 60%. Regional anesthesia techniques like graded epidural anesthesia can be safe and cost-effective by prolonging the postoperative pain relief and thus also effective in blunting autonomic, somatic, and endocrine responses triggered by surgical insult.
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