This case study presents a comprehensive approach to anesthetic management for a 77-year-old female patient diagnosed with hypertrophic obstructive cardiomyopathy (HOCM), seizure disorder, and ileal adenocarcinoma. The patient’s history included significant left ventricular outflow tract (LVOT) obstruction with a gradient of 110 mm Hg, atrial fibrillation, and long-standing seizure management. The surgical procedure involved resection and anastomosis with ileostomy.
HOCM, a genetic disorder, poses anesthetic challenges due to risks of exacerbating LVOT obstruction, arrhythmias, and hemodynamic instability. Key perioperative goals include avoiding tachycardia, preserving sinus rhythm, and ensuring optimal preload and afterload. The case emphasized these principles, demonstrating how meticulous planning and intraoperative management facilitated positive surgical outcomes.
Preoperatively, the patient continued medications such as beta-blockers, anticoagulants, and antiarrhythmic agents to maintain cardiac stability. Bridging anticoagulation with enoxaparin mitigated bleeding risks during surgery. Intravenous access and arterial cannulation provided real-time hemodynamic monitoring, while prophylactic defibrillator pads were applied due to arrhythmia risks.
Anesthesia was induced using etomidate, with vecuronium for intubation. Maintenance relied on a combination of sevoflurane, nitrous oxide, and goal-directed fluid therapy. The case underscored the importance of vasopressors like phenylephrine to manage hypotension while maintaining systemic vascular resistance, critical for preventing LVOT obstruction. Epidural analgesia was utilized for intraoperative and postoperative pain control, reducing sympathetic stimulation and ensuring hemodynamic stability.
Intraoperative challenges included transient hypotension and tachycardia, managed effectively with fluid resuscitation and pharmacological interventions. Blood loss was minimal, and intraoperative monitoring ensured stable heart rates and blood pressure. The patient recovered without complications, resuming normal activities within weeks.
This report highlights the complex interplay between cardiac pathophysiology and anesthetic management in HOCM. Strategies such as vigilant monitoring, tailored medication use, and precise fluid therapy are essential. It also stresses the importance of preoperative optimization and interdisciplinary coordination in managing high-risk patients. The successful outcome demonstrates how careful planning can mitigate risks, providing a framework for managing similar cases in the future.
