Anaesthetic Management In A Heart Transplantation Patient With Amiodarone Associated Thyrotoxicosis

Anaesthetic Management in a Heart Transplantation Patient with Amiodarone Associated ThyrotoxicosisIntroduction: The elective surgery of patients with abnormal thyroid function can be delayed until they are euthyroid with medical treatment. We present the anaesthetic management of a patient with amiodarone associated thyrotoxicosis who underwent heart transplantation.Case Report: A 20- year -old female patient diagnosed as cardiomyopathy developed cardiac tamponade and cardiac arrest following heart biopsy. The patient was resuscitated, after decompresion of cardiac tamponade and amiodarone was started for the management of ventricular premature beats. The patient’s ejection fraction was 30 % as estimated during echocardiography done two years later and thyroid function tests were as follows: FT3: 11.8 pg mL, FT4>12 ng dLve TSH: 0.001 µIU mL. The patient was started on propylthiouracil and metilprednisolone therapy with the diagnosis of thyrotoxicosis secondary to amiodarone therapy. Ventricular tachycardia developed three months later and the patient’s ejection fraction was under 20 % on echocardiography. Ventricular assist device implantation was planned for the patient. Plasmapheresis was performed 3 times and 28 % reduction in FT4 levels was achieved. The patient underwent heart transplantation after a suitable donor heart was found. The patient was monitorized with ECG, pulse oximetry, invasive arterial pressure, central venous pressure, rectal temperature measurements, and transoesophageal echocardiograms. Anaesthesia was induced with ketamine, midazolam, rocuronium, fentanyl and maintained with sevoflurane and propofol. The signs of thyrotoxicosis did not develop during the perioperative period. Conclusion: Amiodarone is at the top of the most widely used drugs in the treatment of arrhthymias. The surgical candidates who are using or have given up using this drug must be followed closely for perioperative complications.