Çok Yüksek Riskli Koroner Arter Hastalığı ve Dejeneratif Kalp Kapağı Olan Bir Hastanın Acil Spinal Cerrahisinde Başarılı Bir Anestezi Uygulaması

In noncardiac surgery of cardiac patients, all efforts during the preoperative assessment are to predict, and prevent potential complications An urgent operation was decided to be performed on a 80-year-old female patient with the diagnosis of depression fracture of L1. During assessment of the patient before anesthesia, we learned that patient had coronary artery disease. During the physical examination, pulmonary edema was detected secondary to the congestive heart failure. The patient was sent to coronary intensive care unit after talking with patient’s relatives and the attending surgeon. After aggressive treatment about a week, blood gas values were improved and hemodynamic values were stabilized. In this condition, we decided operation for the patient. Invasive monitorization was performed in the operation room. For induction of anesthesia, midazolam, fentanyl, rocuronium, and lidocaine were given. The maintenance of anesthesia provided with sevoflurane plus 50 % of air and 50 % of oxygen. The patient remained stable during the operation. A three-hour operation was completed without any problem, and she was remained at a steady state up to the discharge. As a conclusion, each patient should be questioned and examined carefully about cardiac manifestations during the preoperative assessment. In the presence of any sign or symptom of congestive heart failure (CHF), noncardiac surgeries should be postponed if it is not urgent. Such patients should be treated aggressively during the perioperative period according to the functional degree of CHF. In case of emergency, consultation with cardiologists should arrive at a consensus, and patients should be operated under optimal conditions.