Case report: Patient with ischaemic heart disease posted for hemiglossectomy with lymph node dissection

Background: Ischemic heart disease (IHD) continues to be an important cause of morbidity and mortality worldwide. Perioperative care of patients with IHD is a matter of concern, especially in major surgery. Surgery for oral cancer like hemiglossectomy with lymphadenectomy can be very extensive in nature and may be a risk factor for a patient with reduced cardiac functionCase Presentation: We present a case of a 71-year-old female patient with a history of IHD, hypertension, and type II diabetes mellitus who was admitted with an ulcerative tongue lesion on the left lateral border. She was posted for hemiglossectomy and left neck dissection. Patient's cardiac history was a 2016 myocardial infarction (MI), and the drugs were dual antiplatelet therapy (aspirin and clopidogrel), a statin (rosuvastatin), and anti-hypertensive and anti-diabetic therapy. Preoperative assessment showed left bundle branch block (LBBB) on electrocardiogram (ECG) and 2D echocardiogram demonstrated an ejection fraction (EF) of 45% with apical and anteroseptal segment akinesia. In spite of cardiac comorbidities, the patient underwent a successful procedure with a suitable anesthetic protocol, perioperative care, and aggressive postoperative care.Discussion: This report demonstrates the benefit of accurate preoperative risk stratification, cardiac function optimization, and meticulous perioperative planning to reduce the number of adverse events in patients with compromised cardiac status who are scheduled for major head and neck operations. Specific attention to dual antiplatelet therapy, hemodynamic monitoring, anesthetic management, and blood glucose control is emphasized.Conclusion: Adequate preoperative cardiac evaluation, individualized anesthetic planning, and multidisciplinary collaboration are critical to achieving favorable outcomes in patients with IHD who require hemiglossectomy with lymph node dissection.