Anesthesia and Anesthesiological Strategies in a Patient With Severe Left Ventricular Dysfunction Undergoing Prostatectomy

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.