Cardiac patient coming for Non cardiac surgery – A retrorespective case discussion

Scenario / case 1

Mr.kesava, 68year old gentleman, came to PAC clinic on 30/1/2026 Asa 3, known htn on tab.Nebicard 2.5 mg od

hypothyroid on eltrox 12.5mcg, Bph on Tamsulosin hs

Prophylactic tab.ecospirin, atorvas 10mg

Ca – hypopharynx {post pharyngeal wall} s/p chemo /radiotherapy, now has come for Laryngopharyngoesophagectomy with permanent tracheostomy  and gastric pullup..

Preanaesthetic checkup:

General examination :wnl Vitals :stable

Airway : mouth opening >2fb, mallampati grade 3, no neck restriction, fixed dentures+. Systemic : wnl except for a murmur radiating to carotid.

Blood investigation :wnl, Tsh 22.5,

ecg:Sr, lvh, Rbbb.

Echo:Ef:60%, No rwma, calcified aortic valve with SEVERE CRITICAL AORTIC STENOSIS{Pg-130mmhg}, mod AR.

Chest xray : prominent aortic knuckles, hilar prominence .

PERIOP – Optimization

1. Cardiologist opinion: Advised – TRANSCATHETER AORTIC VALVE IMPLANTATION prior to non cardiac surgery, After a team panel discussion of – cardiplogist, surgeon, anaesthetist with the patient and attender reagrding the prior need for TAVI, the pt underwent tavi on 11/2, was put on anticoagulant TAB – ABIXABAN till 5/03, Post Tavi echo :EF:62%, no rwma.cardiac ct :Aortic valve in satisfactory position.
2. endocrinologist opinion for raised TSH:mod risk, can proceed.
3. Arrangenmet of blood products.
4. Pre rehabilitation and counselling for risk and complication, outcome.

Intraop:

1. ASA monitors
2. 2 large gauge cannula iv, inortopes on standby
3. Arterial line
4. dvt stocking, warmer, foleys, ryles

General anaesthesia with opiods, sedatives and muscle rekaxant.

EVENTS: Intraop patient had a smooth induction with good holding of vitals, but during laproscopic mobilization of esophagus and gastric pull up,pt had severe hypotension with bradycardia momentarily ,picked up within few seconds with iv fluids, and minimal pressor supports.

Pateint was shifted off pressors, good abg, adequte output to icu for EPOV inview of major sx, Next day he was weaned off o2, on thermovent with tracheostomy.

Valvular disease – AORTIC STENOSIS

Aortic stenosis is a slow progressive obstruction of left ventricle outflow, leading to pressure hypertrophy pf lv, with symptoms of sudden syncope, angine, breathlessness, palpitation.

Types – based on valve area and pressure gradient Mild

Moderate Severe Critical AS

Dr. Jamila Khatoon
Senior Consultant Anaesthesiologist
Kauvery Hospital, Chennai.[1]

Dr. Varun
3rd Year DnB Candidate
Kauvery Hospital, Chennai.[1]