Expert: Ronald Levy, M.D. - 6/11/2008

Question
QUESTION: Dr. Levy,

My father-in-law, 84, has had a heart attack about 9 years ago. His heart is doing fine since the surgery. Now he is suffering from deterioration of the hip bone. His kidneys are not in great shape and he has an annurism right around his belly button area. His heart doctor does not want him to have the hip replacement because of the anestigia. Can an epidural be used instead?

ANSWER: There are many ways to do the anesthesia here (including an epidural). We do general anesthesia all the time for people like you father-in-law and probably with even worse hearts. When he comes in for his presurgical anesthesia visit, they will determine the best anesthetic for him. Personally, I would be more concerned with his kidneys and aneurysm than his heart (if you say that he is otherwise fine in that respect).

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Dr. Levy,

We went to his GP yesterday and the GP said that he has 50% damage to his kidneys and that is the reason that he would not be cleared for surgery for his hip. Now, in respect to the aneurysm, why can that not be bypassed? Apparently, the aneurysm is in between the kidneys from what I understood from the GP. Again, thank you for your help.

Answer
50% damage to the kidneys is no reason not to have anesthesia (we do anesthesia in patients with 100% failure). We tailor our anesthestic to the medical condition of the patient. As for the aneurysm, that can be repaired (either endovascular or open but also requires some anesthesia.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston