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This case study highlights successful anesthesia management for a high-risk patient with pulmonary hypertension and right heart failure. Sedation with dexmedetomidine and rectus sheath blocks provided safe surgical anesthesia, avoiding general anesthesia risks.

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Area of Science:

  • Anesthesiology
  • Cardiology
  • Neurosurgery

Background:

  • A 44-year-old male, ASA class IV, presented for anal condyloma fulguration and diverting colostomy.
  • Medical history includes World Health Organization class I pulmonary hypertension, right heart failure, and Pott's disease-induced paralysis.

Observation:

  • Patient was unsuitable for neuraxial anesthesia due to sacral decubitus ulcers.
  • General anesthesia posed a high risk of right ventricular failure.

Findings:

  • Anesthesia was successfully achieved using sedation with dexmedetomidine infusion.
  • Bilateral rectus sheath blocks provided effective surgical anesthesia.

Implications:

  • This approach offers a viable alternative to general anesthesia in high-risk patients.
  • Dexmedetomidine sedation and regional blocks can mitigate risks associated with pulmonary hypertension and right heart failure.