CASE REPORT
ANESTHESIA AND ANESTHESIOLOGICAL STRATEGIES IN A PATIENT WITH SEVERE LEFT VENTRICULAR DYSFUNCTION UNDERGOING PROSTATECTOMY

UDK: 616.12-005.4:616.65-006.6-089.87-089.5

Panovska-Petrusheva A1, Gavrilovska-Brzanov A1, Shirgoska B2, Shabani B3, Temelkovska-Stevanovska M1,  Nikolovska S1

 

1 PHI University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation,

Intensive Care and Emergency Centre, Medical Faculty, “Ss Cyril and Methodius” University, Skopje, Macedonia (TOARICEC).

2 Clinic for Ear, Nose and Throat Surgery, / Anesthesiology Department, Medical Faculty, University “Ss Cyril and Methodius” Skopje, Macedonia.

3 Clinic for Urology, Medical Faculty, “Ss Cyril and Methodius” University, Skopje, Macedonia.

 

Abstract

 

This case describes the perioperative management of a 62-years-old male with a complex medical history, including ischemic heart disease (IHD), type 2 diabetes, hypertension, hyperlipidemia, chronic heart failure and a prior myocardial infarction (MI), requiring stenting. He was scheduled for prostatectomy due to prostate cancer and had a left ventricular ejection fraction (LVEF) of 37%, reflecting chronic dilated cardiomyopathy.

The patient was transitioned from oral anticoagulants to low-molecular-weight heparin preoperatively, and his glycemia was well-controlled. A carefully tailored anesthetic plan was implemented. The patient’s vital signs remained stable throughout the three-hours surgery, with no immediate postoperative complications, and pain control was effectively managed.

Despite the patient’s complex medical background, he emerged from surgery in stable condition and is currently recovering well, with ongoing radiation therapy for his prostate cancer. This case highlights the vital importance of thorough preoperative assessment, careful anesthetic management and continuous postoperative monitoring, in high-risk patients with cardiovascular comorbidities, underscoring the need for tailored treatment to prevent complications like MACE and MINS and to improve overall outcomes.

 

Key Words: Anesthesia for high-risk patients; chronic dilated cardiomyopathy; mortality risk.

 

Conclusion

 

The substantial risks involved in treating individuals with ischemic heart disease (IHD) having non-cardiac surgery are highlighted by this example. The significant death rate among these patients emphasizes the necessity of thorough preoperative assessment and careful perioperative care. In order to lower risks and enhance results in high-risk surgical patients, this instance highlights the significance of personalized care.

 

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