Key result
Dynamic hemodynamic monitoring and application of a magnet to the AICD allowed for successful and uneventful anesthetic management of a patient with severe ischemic cardiomyopathy undergoing surgery.
Why the study?
Ischaemic cardiomyopathy with low ejection fraction and an in situ automated implantable cardioverter-defibrillator poses significant perioperative challenges during major surgery.
Case Report (n=1)
Careful anesthetic management, including dynamic hemodynamic monitoring and magnet application to suspend AICD anti-tachycardia functions, enables successful major abdominal surgery in patients with severe ischemic cardiomyopathy.
Answers are grounded in this paper and cite their sources.
Supports feasibility of major surgery in severe ischemic cardiomyopathy with AICD; hypothesis-generating and requires prospective validation.
Ischaemic cardiomyopathy with low ejection fraction (EF) poses a perioperative challenge to the anesthetist due to the risk of hemodynamic instability, cardiovascular collapse, and heart failure. More so when a patient has an Automated Implantable Cardiovertor Defibrillator (AICD) in situ. We report the anesthetic management of a patient with ischaemic cardiomyopathy with an EF of 20% and AICD in situ posted for open right hemicolectomy. Dynamic hemodynamic monitoring with preparedness to manage fluid shifts, hemodynamic fluctuations, and adequate pain management is essential to successful anesthetic management in patients with an AICD, where programming is not possible.
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Saini et al. (2023) conducted a case report in Ischemic cardiomyopathy with low ejection fraction and AICD in situ undergoing major abdominal oncosurgery (n=1). Anesthetic management with dynamic hemodynamic monitoring and AICD magnet application was evaluated on Successful anesthetic management and hemodynamic stability. Dynamic hemodynamic monitoring and application of a magnet to the AICD allowed for successful and uneventful anesthetic management of a patient with severe ischemic cardiomyopathy undergoing surgery.
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