Neuraxial anesthesia produces a sympathectomy and parasympathetic dominance, resulting in relaxation of sphincters, constriction of the bowel, and an increase in secretions. This imbalance of the autonomic nervous system has also been implicated in the occurrence of nausea seen with neuraxial blockade. Hepatic blood flow is related to mean arterial pressure, and thus is maintained if the patient is hemodynamically stable. Similarly, renal blood flow and renal function are preserved during spinal anesthesia when perfusion pressure is adequate. Urinary retention after spinal anesthesia is the most noteworthy and clinically significant concern in regard to the genitourinary system. Postoperative urinary retention occurs in about 16% of patients in the recovery unit. The ability to void normally does not return until sensory anesthesia has regressed to the S3 sacral segment. Prolonged inhibition of normal detrusor function with the use of long-acting local anesthetics such as bupivacaine may allow bladder overdistention and urinary retention. Factors such as age (older than 50 years), volume of intraoperative fluid administration, and type of surgical procedure influence the rate of urinary retention.

Neuraxial anesthesia  is rarely contraindicated on the basis of respiratory disease. Patients with pulmonary disease have not been documented to be at higher risk for respiratory complications than normal patients when receiving neuraxial. Spinal or epidural anesthesia does not adversely affect oxygenation during single lung ventilation and does not affect hypoxic pulmonary vasoconstriction. Neuraxial anesthesia does not cause bronchoconstriction and it is safe to perform spinal or epidural anesthesia on asthmatic patients. Indeed, during epidural anesthesia in which epinephrine is added to the administered local anesthetic bronchodilation may result.

Neuraxial anesthesia is an alternative to general for certain surgical procedures. Neuraxial anesthesia subsumes spinal and epidural anesthesia. Local anesthetics are injected into the spinal canal for spinal anesthesia or into the epidural space for epidural anesthesia. Each type of neuraxial anesthesia blocks afferent and efferent neuronal pathways within the spinal cord, thereby impairing both central and peripheral thermoregulatory control. As a result, hypothermia can be observed in patients given spinal or epidural anesthesia. Despite transient paralysis of the lower body, hypothermia commonly provokes shivering in the nonblocked upper body. Peripheral nerve blockade does not affect the cardiovascular system as much as neuraxial or general anesthesia. Therefore, peripheral nerve blockade should be proposed to HF patients, whenever it is applicable.

During general anesthesia, the objective is to maintain homeostasis as much as possible. In order to control loading conditions on the left ventricle and maintain a balanced rate of fluids infusion/lost, the monitoring of invasive arterial pressure and cardiac output should be considered. Anesthetic drugs should be titrated to use the minimal amount of drug to obtain the intended effects with limited adverse effects, by monitoring the depth of anesthesia Finally metabolic constrains should be closely watched in order to avoid hypercapnia, hypoxia, hypothermia, and anemia