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VOLUME 5 , ISSUE 1 ( January-March, 2022 ) > List of Articles

CASE REPORT

Anesthetic Management of Patient with Global Left Ventricular Systolic Dysfunction Posted for Transurethral Resection of Prostrate and Bilateral Hernioplasty

Divya Senthilkumar, Dilip K Govindan, T Krishna Prasad

Keywords : Epidural anesthesia, Noncardiac surgeries, Subarachnoid block, Systolic dysfunction

Citation Information : Senthilkumar D, Govindan DK, Prasad TK. Anesthetic Management of Patient with Global Left Ventricular Systolic Dysfunction Posted for Transurethral Resection of Prostrate and Bilateral Hernioplasty. 2022; 5 (1):10-12.

DOI: 10.5005/jp-journals-10082-03137

License: CC BY-NC 4.0

Published Online: 30-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Anesthetic management of cardiac patients for noncardiac surgeries can be challenging and can be associated with both intraoperative and postoperative complications. Care of these patients requires identification of risk factors, preoperative evaluation and optimization, medical therapy, monitoring, and the choice of appropriate anesthetic techniques and drugs. A 70-year-old male, with past history of cardiovascular accident (CVA) and no other known comorbidities, had complaints of lower urinary tract symptoms, gradually worsening over the past 20 days and developed urinary retention 4 days back, diagnosed with benign prostatic hypertrophy (BPH), after obtaining a 2D echo [showing global hypokinesia with severe left ventricular (LV) systolic dysfunction, ejection fraction (EF)-30%] with cardiologist opinion posted for transurethral resection of prostrate (TURP) and bilateral hernioplasty under regional anesthesia (lumbar epidural anesthesia with subarachnoid block—1.2 mL of 0.5% bupivacaine with 25 µg fentanyl), under moderate cardiac risk. The patient was hemodynamically stable intraoperatively and perioperatively. The patient was continuously monitored perioperatively and cardiac drugs like diuretics, beta-blockers, statins, and angiotensin receptor neprilysin inhibitor (ARNI) were continued after obtaining a cardiologist review. Thus in patients with moderate risk cardiac illness, who are posted for noncardiac surgeries, the more preferable and safer alternative is regional anesthesia as it reduces the sympathetic stress response which is present while performing general anesthesia (during intubation and extubation).


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