- Classically neuraxial anaesthesia is avoided in severe aortic stenosis:
- Causes reduction in SVR and thus systemic hypotension
- Fixed obstruction impedes compensatory increase in cardiac output
- Can result in spiral of decreased coronary perfusion, ischaemia, further hypotension and death
- Continuous spinal or combined spinal epidural anaesthetic techniques may be used in patients with aortic stenosis
- Allow slow titrated onset of anaesthesia with administration of drugs to maintain blood pressure
- Risks of neuroaxial anaesthesia must be clearly explained to the patient
