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[A man with severe dilated cardiomyopathy with implantable cardioverter-defibrillator who underwent sigmoidectomy]

Kenji Iwamuro1, Yuko Hamada, Toshiya Koitabashi

  • 1Department of Anesthesiology, Ichikawa General Hospital, Tokyo Dental College, Chiba 272-8513.

Masui. the Japanese Journal of Anesthesiology
|September 23, 2010
PubMed

Insights

This case study details managing a patient with severe dilated cardiomyopathy and an implantable cardioverter-defibrillator during sigmoidectomy. The successful surgical approach prevented heart failure and device malfunction.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Surgical Oncology

Background:

  • Severe dilated cardiomyopathy necessitates careful management during non-cardiac surgery.
  • Implantable cardioverter-defibrillators (ICDs) require specific precautions during electrocautery use to prevent malfunction.

Observation:

  • A patient with a severe dilated cardiomyopathy and an ICD underwent a sigmoidectomy.
  • ICD defibrillation was temporarily deactivated, and external defibrillator pads were used.
  • Pulmonary artery catheter insertion was guided by X-ray to avoid lead interference.

Findings:

  • Combined general and thoracic epidural anesthesia was employed.
  • Milrinone and carperitide were administered to prevent afterload increase.
  • Fluid resuscitation maintained adequate circulating blood volume.

Implications:

  • This multidisciplinary approach ensured patient safety during major surgery.
  • Effective perioperative management prevented adverse cardiac events in a high-risk patient.
  • The strategy highlights successful coordination between cardiology, anesthesia, and surgery for complex cases.

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