Unilateral Spinal vs General Anaesthesia in Low EF Patients: A Hemodynamic Comparison

Patients (Selected for Unilateral Spinal Anaesthesia, UniSA) will be positioned laterally with the operative side dependent. Following aseptic preparation, Patient will be given a small volume of preload of Ringer Lactate (3-5ml /kg) i.e 250-300ml to avoid Spinal induced hypotension and to minimize fluid overload due to reduced ejection fraction. After giving preload, A 25-gauge Quincke needle will be introduced at the L3-L4 interspace, and 1.0 ml (7.5 mg) of 0.75% hyperbaric bupivacaine will be injected intrathecal. The lateral position will be maintained for approximately 10 minutes to achieve a unilateral block. Analgesia will also be maintained by using Ketorolac and Acetaminophen if there would be any complain of Pain. Continuous monitoring of HR, MAP, and SpO₂ will be undertaken to ensure stability

Anaesthesia induction will be achieved with IV propofol (1-2 mg/kg) and nalbuphine (0.1 mg/kg) for analgesia. Neuromuscular relaxation will be achieved with atracurium (0.5 mg/kg) and additional doses will be given as needed. Anaesthesia will be maintained with isoflurane in a mix of oxygen and air. If the heart rate or mean arterial pressure rises by more than 20% from baseline, an extra dose of nalbuphine (2 to 3 mg IV) will be given. Analgesia will also be maintained by using Ketorolac and Acetaminophen. At the end of surgery , Remaining muscular relaxation will be neutralized by administering neostigmine (0.05mg/kg)