[Total intravenous anesthesia for a patient with cardiac sarcoidosis associated with left ventricular dysfunction...

An 81-year-old man with cardiac sarcoidosis was scheduled for an open colectomy and partial resection of liver metastasis. He had undergone implantation of a permanent cardiac pacemaker for complete atrioventricular block 5 years before. Preoperative echocardiography revealed severely reduced left ventricular function, with an ejection fraction of 30%. General anesthesia was induced and maintained with remifentanil 0.2 microg x kg(-1) x min(-1), along with a target-controlled infusion of propofol combined with intermittent administrations of low-dose fentanyl. Perioperative hemodynamic monitoring with a pulmonary artery catheter and transesophageal echocardiography was useful for management of cardiac function and control of infusion volume. The surgery was conducted uneventfully and the patient entered the ICU without endotracheal intubation. Thereafter, the postoperative course was stable without major complications. Cardiac sarcoidosis is characterized by a high incidence of complete atrioventricular block, ventricular arrhythmia, and cardiac dysfunction. We consider that a combination of remifentanil and propofol is useful for careful anesthetic management of patients with cardiac sarcoidosis.