[Anesthetic management of a hemodialysis-dependent patient implanted with a CRT-D device undergoing an operation for...

Area of Science:

• Cardiology
• Anesthesiology
• Critical Care Medicine

Background:

• A 53-year-old male patient with dilated cardiomyopathy, implanted with a cardiac resynchronization therapy with defibrillator (CRT-D) device, presented with a perforated sigmoid colon requiring emergency surgery.
• The patient was also undergoing chronic hemodialysis, adding complexity to his medical management.

Observation:

• Anesthetic management involved disabling the CRT-D defibrillation function, changing pacing mode, and external defibrillator preparedness.
• Hemodynamic support was maintained with vasopressors (dopamine, norepinephrine) to keep systolic blood pressure between 70-80 mmHg and central venous pressure (CVP) between 8-13 mmHg.
• Postoperatively, the patient received intensive care, including mechanical ventilation, continuous hemodiafiltration, and direct hemoperfusion.

Findings:

• Despite intensive care, the patient succumbed to multiple organ failure 48 days after surgery.
• The case underscores the critical need for specialized anesthetic protocols in patients with CRT-D devices undergoing emergent procedures.

Implications:

• Anesthetic management for patients with implanted cardiac devices, particularly CRT-D, necessitates meticulous planning and intraoperative monitoring.
• This case emphasizes the importance of multidisciplinary collaboration between cardiology, anesthesiology, and critical care teams for optimal patient outcomes.
• Further research and standardized guidelines are warranted for the perioperative care of patients with CRT-D devices.