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April 11, 1986

Spinal Anesthesia in Obstructive Cardiomyopathy

Author Affiliations

The Bowman-Gray School of Medicine Winston-Salem, NC

JAMA. 1986;255(14):1882. doi:10.1001/jama.1986.03370140080025

To the Editor.—  The authors of the recent article on perioperative anesthetic risks in patients with hypertrophic obstructive cardiomyopathy that appeared in The Journal,1 make claims regarding the safety of spinal anesthesia that would seem unwarranted. A single instance of myocardial infarction in a patient with coronary artery disease, as well as obstructive cardiomyopathy, is used as evidence for avoiding spinal anesthesia. Such a blanket recommendation would seem ill-advised.There is no mention in the article of the level of spinal anesthesia employed in the four instances in which it was used. There are major differences between low and high dermatomal levels of spinal anesthesia in their hemodynamic consequences. For example, saddle block anesthesia for a patient requiring dilatation and curettage of the cervix would not be expected to produce the profound changes in venous capacitance and arterial resistance that are seen when high levels of spinal anesthesia are