Gupta R, Arora D, Kaur S, et al. - Reliable spinal anesthesia (SA) with minimal hypotension is achievable because of synergism between intrathecal opioids and low dose local anesthetics. In this study, the hemodynamic effects of reduced dose of 0.5% intrathecal bupivacaine (2mL) with 25 μg butorphanol were compared between cardiac vs non-cardiac patients. Sixty patients aged 30-80 years, undergoing infraumbilical surgeries, were included and 30 cardiac patients with mild to moderate reduction in left ventricular ejection fraction (LVEF) on 2D echocardiography (Group C) were compared with 30 non-cardiac patients (Group NC) for similar types of surgery. Patients in both the groups were administered 0.5% bupivacaine 2.0 ml with 25 μg butorphanol. The two groups were similar regarding the spinal block characteristics. Outcomes suggest that spinal anesthesia with 10 mg bupivacaine and 25μg butorphanol can be safely considered in cardiac patients with mild to moderately reduced ejection fraction presenting for infraumbilical non-cardiac surgeries with the advantage of intraoperative hemodynamic stability and adequate postoperative analgesia.