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[Perioperative management of two patients with severe dilated cardiomyopathy]
1Department of Anesthesiology, Okayama Rosai Hospital.
Insights
Managing severe dilated cardiomyopathy (ejection fraction 18-30%) requires careful preoperative evaluation and treatment of congestive heart failure. Safe anesthesia is achievable with continuous monitoring for patients with advanced heart failure.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Severe dilated cardiomyopathy (DCM) poses significant perioperative risks, particularly for patients classified as Inoh Group IV.
- These patients often present with severe congestive heart failure (CHF) preoperatively, complicating management.
- Optimal management strategies are crucial to mitigate intraoperative and postoperative complications.
Observation:
- Two patients with Inoh Group IV DCM (ejection fraction 18% and 30%) experienced severe CHF preoperatively.
- Pharmacological interventions including dopamine, dobutamine, and furosemide were administered to enhance cardiac function.
- Anesthesia was successfully administered utilizing continuous cardiac output and mixed venous saturation monitoring.
Findings:
- Preoperative optimization of cardiac function and management of CHF are critical for patients with severe DCM.
- Continuous hemodynamic monitoring (cardiac output, mixed venous saturation) facilitates safe anesthetic conduct.
- Effective perioperative strategies can prevent severe complications in this high-risk patient population.
Implications:
- This case report highlights the importance of thorough preoperative assessment and tailored medical management for severe DCM patients.
- It underscores the feasibility of safe anesthesia and surgical procedures in these patients with appropriate monitoring and support.
- Findings emphasize the need for multidisciplinary collaboration in managing complex cardiac conditions perioperatively.
Abstract:
We report perioperative management of two patients with severe dilated cardiomyopathy belonging to the group IV of classification of Inoh (ejection fraction 18% and 30%). In the preoperative period, they developed severe congestive heart failure. Dopamine, dobutamine, and furosemide were given to improve cardiac function. Anesthesia was performed safely under continuous cardiac output and mixed venous saturation monitoring. We consider that preoperative evaluation and management are very important to prevent intraoperative and postoperative complications in patients with severe dilated cardiomyopathy.