Anaesthesia in a patient with severe ischemic heart disease: Case report [Agir i·skemik kalp hastasina anestezik yaklaşimimiz]

We describe our experience of thorocal epidural anesthesia (TEA) in combination with general anesthesia in a male patient undergoing operation due to adenocarcinoma of the stomach. The patient 65 years old had a coronary angiography revealing that LAD 100%, 1.diagonal 98%, 1. septal 100% and circumflex 100% were occluded. After obtaining written informed consent, he has been taken to the operation room for monitorization. In the sitting position, epidural catheterisation was performed through T7-8 interspace. 200 mg 2% prilocain and 25 mg 5% bupivacain in a total volume of 15 ml were injected via the catheter. Anesthesia was induced with 2 mg/kg lidocain, 2 microgram/kg fentanyl, 2 mg/kg propofol and 0,1 mg/kg vecuronium. Maintanance was provided by 0.5% isoflurane in 50% O2 and N2O mixture. We observed no complication during pertoperative period. The patient has been discharged with coronary artery bypass grafting (CABG) suggestion. Tea in combination with general anesthesia was performed to decrease anesthetic and surgical risks. We aimed not only to increase O2 delivery and decrease of consumption tea by coronary vasodilation due to sympathetic blockage, but also decrease autonomic and endocrine response, obtain a hemodynamic stability and succeed postoperative analgesia. Copyright © 2010 by Türkiye Klinikleri