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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims The use of central regional anesthesia is traditionally regarded as contraindicated in patients with severe aortic stenosis (AS) due to the risk of hypotension, decreased coronary perfusion, and acute myocardial ischemia. However, there is no high-level literature evidence in support of this recommendation. Since cardiovascular monitoring systems, diagnostics, pharmacology, and clinical practice patterns have improved, we polled anesthesiology practitioners to gauge their opinion on whether spinal anesthesia should remain contraindicated in patients with moderate-to-severe AS.

Methods We surveyed the anesthesiology community of NYSORA to assess practitioners’ perception of whether or not spinal anesthesia is contraindicated in patients with moderate-to-severe AS (the definition according to the 2014 AHA/ACC guidelines for the severity of AS).

Results A total of 130.000 NYSORA community members were polled. Of these, 82% comprised anesthesiology practitioners. A total of 1,400 (1.1%) community members posted a reply, figure 1. Most respondents (68%) opined that spinal anesthesia is contraindicated in patients with moderate- to-severe AS.

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Abstract #36082 Figure 1

NYSORA community poll results

Conclusions Our poll results suggest that anesthesia practitioners continue to consider spinal anesthesia as contraindicated in patients with moderate-to-severe AS, although neuraxial anesthesia may be associated with better outcomes (e.g., in patients having joint replacement surgery). In view of the advances in monitoring and possible advantages of spinal anesthesia in specific populations, we believe that its safety in patients with AS should be formally evaluated.