Abstract:
Hypertrophic obstructive cardiomyopathy (HOCM) is a challenge to anesthesiologists due to
the complex pathophysiology involved and various perioperative complications associated
with it. We present a 50‐year‐old man, a known case of HOCM, who successfully underwent
emergency haemostasis, and debridement of the traumatically amputated right upper limb and
the contused lacerated wound on the left forearm under bilateral brachial plexus blocks. His
co‐morbidities included hypertension (in hypertensive crisis) and diabetes mellitus. He was
full stomach and also had an anticipated difficult airway. The management included invasive
pressure monitoring and labetalol infusion for emergent control of blood pressure. The regional
anaesthesia technique required careful consideration to the dosage of local anaesthetics and
staggered performance of brachial plexus blocks on each of the upper limbs to avoid local
anaesthetic toxicity. Even though bilateral brachial plexus blocks are rarely indicated, it seemed
to be the most appropriate anaesthetic technique in our patient. With careful consideration
of the local anaesthetic toxicity and meticulous technique, bilateral brachial plexus blocks
can be successfully performed in those patients where general anaesthesia is deemed to be
associated with higher risk.
