Spinal anesthesia for a neonate with complex congenital heart disease for lower limb surgery

Abstract

A neonate with complex congenital heart disease was referred for patent ductus arteriosus (PDA) stenting, who had an ulceration of the dorsum of the foot secondary to extravasation injury. Echo showed situs solitus, levocardia, atrioventricular concordance, double-outlet right ventricle, large inlet with conoventricular ventricular septal defect, bidirectional shunt, D-posed aorta, pulmonary atresia, confluent good-sized branch pulmonary arteries, left arch, no coarctation, and tortuous PDA arising from the base of arch supplying the branch pulmonary artery confluence. Three days later, PDA stenting was done. As limb ulceration progressed to cellulitis, he was posted for debridement and VAC application 6 days after PDA stenting. It was performed under subarachnoid block with 0.5% bupivacaine heavy 0.6 ml through L4-L5 interspace using a 24G needle. Intraoperatively, saturation and hemodynamic variables remained stable. Skin grafting was performed 3 days later under spinal anesthesia with an unremarkable intraoperative and postoperative period.