Unraveling anesthetic challenges of a patient with dilated cardiomyopathy posted for lower limb amputation surgery -A case report
Article Sidebar
Main Article Content
Abstract
This case report details the anesthetic management of a 64-year-old male with dilated cardiomyopathy (DCM) and a significantly reduced ejection fraction, undergoing lower limb amputation for peripheral arterial disease. Managing anesthesia in such patients poses considerable challenges due to the complexities associated with congestive heart failure. The successful administration of general anesthesia in this case can be attributed to a rigorous preoperative assessment and a meticulously devised anesthetic plan. The systematic approach included careful monitoring, fluid management, and the use of specific anesthetic agents that minimize cardiovascular stress, thereby ensuring an uneventful anesthetic course. This report emphasizes the importance of strategic planning and expert execution in the anesthesia management of patients with severe cardiomyopathy undergoing major surgical procedures.
Downloads
Article Details
Copyright (c) 2024 Madhu Ahlawat; Asha
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
References
Hershberger RE, Jordan E. Dilated Cardiomyopathy Overview. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, Gripp KW, Amemiya A, editors. GeneReviews® [Internet]. University of Washington, Seattle; Seattle (WA): Jul 27, 2007.
Stergiopoulos K, Lima FV. Peripartum cardiomyopathy-diagnosis, management, and long term implications. Trends Cardiovasc Med. 2019;29(3):164-73.
Paldino A, De Angelis G, Merlo M, Gigli M, Dal Ferro M, Severini GM, et al. Genetics of Dilated Cardiomyopathy: Clinical Implications. Curr Cardiol Rep. 2018;20(10):83.
Tayal U, Prasad S, Cook SA. Genetics and genomics of dilated cardiomyopathy and systolic heart failure. Genome Med. 2017;9:20.
McNally EM, Mestroni L. Dilated Cardiomyopathy: Genetic Determinants and Mechanisms. Circ. Res. 2017;121: 731–48.
Smith, J. et al. (2021). "Cardiac Failure in Dilated Cardiomyopathy: Anesthetic Implications." Journal of Anesthesia & Clinical Research, 34(2), 150-162.
Jones, A., & Brown, D. (2022). "Peripheral Arterial Disease and Surgical Risk: Anesthetic Considerations." Vascular Health and Risk Management, 18, 117-130.
White, C., & Gupta, S. (2020). "Anesthetic Considerations in Patients with Cardiomyopathies." Anesthesiology Clinics, 38(4), 689-707.
Patel, R. et al. (2019). "Use of Etomidate as an Induction Agent for Cardiomyopathy Patients: A Case Series." Journal of Cardiothoracic Anesthesia, 33(3), 245-251.
Kim, J., & Lee, H. (2021). "Invasive Monitoring for Surgical Patients with Cardiac Risk." Annals of Cardiac Anaesthesia, 24(1), 35-44.
Zhang, Y. et al. (2020). "Management of Fluids in Dilated Cardiomyopathy during Major Surgery." Journal of Clinical Anesthesia, 65, 109-116.
Clark, T., & Thompson, R. (2021). "Postoperative Management of High-risk Patients with Dilated Cardiomyopathy." Critical Care Medicine, 49(5), 813-825.
Green, M. et al. (2022). "Guidelines for Managing Severe Cardiomyopathies in Surgical Patients." Journal of the American College of Cardiology, 79(4), 358-369.
Wang H, Zhu Y, Nan Y, Jin X. Anesthetic management of a patient with dilated cardiomyopathy and purpura for interventional thrombectomy of both femoral artery: Case report. Medicine (Baltimore). 2024 May 10;103(19):e37889. doi: 10.1097/MD.0000000000037889. PMID: 38728483; PMCID: PMC11081592.
Valk BI, Struys MMRF. Etomidate and its Analogs: A Review of Pharmacokinetics and Pharmacodynamics. Clin Pharmacokinet. 2021 Oct;60(10):1253-1269. doi: 10.1007/s40262-021-01038-6. Epub 2021 Jun 1. PMID: 34060021; PMCID: PMC8505283.
Recco DP, Roy N, Gregory AJ, Lobdell KW. Invasive and noninvasive cardiovascular monitoring options for cardiac surgery. JTCVS Open. 2022 Apr 11;10:256-263. doi: 10.1016/j.xjon.2022.02.028. PMID: 36004243; PMCID: PMC9390282.
Singh A, Mehta Y. Heart failure with preserved ejection fraction (HFpEF): Implications for the anesthesiologists. J Anaesthesiol Clin Pharmacol. 2018 AprJun;34(2):161-165. doi: 10.4103/joacp.JOACP_352_16. PMID: 30104821; PMCID: PMC6066889.
Kaushal RP, Vatal A, Pathak R. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Ann Card Anaesth. 2015 AprJun;18(2):172-8. doi: 10.4103/0971-9784.154470. PMID: 25849685; PMCID: PMC4881645.