Hemicolectomy in a patient with aortic valve disease: Case report

  • María Ángeles Rodríguez-Navarro Hospital General Universitario José Ma Morales Meseguer, Anaesthesia, Resuscitation and Pain Therapy Service, Murcia, Spain
  • Daniel Rastrollo-Peña Hospital General Universitario José Ma Morales Meseguer, Anaesthesia, Resuscitation and Pain Therapy Service, Murcia, Spain
  • Juan Iranzo-Reverter Hospital General Universitario José Ma Morales Meseguer, Anaesthesia, Resuscitation and Pain Therapy Service, Murcia, Spain
  • José Luis Sánchez-Ortega Hospital General Universitario José Ma Morales Meseguer, Anaesthesia, Resuscitation and Pain Therapy Service, Murcia, Spain
  • Rosario García-Fernández Hospital General Universitario José Ma Morales Meseguer, Anaesthesia, Resuscitation and Pain Therapy Service, Murcia, Spain
  • Clara Díaz-Alejo Hospital General Universitario José Ma Morales Meseguer, Anaesthesia, Resuscitation and Pain Therapy Service, Murcia, Spain
Keywords: Colectomy, Anesthesia, Monitoring intraoperative, Aortic valve, Heart diseases

Abstract

Patients with valve disease are at a higher risk of perioperative complications in the context of non-cardiac surgery. The active involvement of the anaesthetist from the moment of the pre-anaesthesia assessment to determine the severity of the disease is crucial.

The purpose of this report on the management of a clinical case is to highlight the need for a multidisciplinary approach to the patient with heart disease.

We present the case of a patient in the eighth decade of life with severe aortic stenosis, and a 46 mm infra-renal abdominal aortic aneurysm; chronic obstructive pulmonary disease, controlled arterial hypertension; and a lymphoproliferative process. Following the pre-anaesthesia assessment, valve repair surgery was indicated prior to a surgical procedure for colon cancer resection. Key to the successful management of this patient was pre-operative optimization with cardiac surgery and adjustment of the pharmacological treatment, plus haemodynamic monitoring as a basis for decision-making during the perioperative period using a minimally invasive device (Vigileo®). Spinal analgesia with intrathecal morphine was combined with general anaesthesia. The patient remained stable with CI 2.3-3l/min/m2, SVV 2-7% and ScvO2 74-67%.

As a result of the successful anaesthetic and surgical process, we concluded that it is our duty at the present time to know and apply the recommendations contained in the guidelines developed by the anaesthesia and cardiology societies and their regular updates, as they allow clinicians to make decisions in accordance with evidence-based protocols.

References

1. Committee on Standards Practice Parameters, Apfelbaum JL, Connis RT, Nacinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, et al. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force o Preanesthesia Evaluation. Anesthesiology. 2012;116:522-38.

2. Kristesen SD, Knuuti J, Saraste A, Anker S, Botker HE, De Heart S, et al. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the Europea Society of Anaesthesiology (ESA). 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur Heart J. 2014;35:2383-431.

3. Martín CE, Castalio M, Gómez-Plana J, Gualis J, Martínez JM. Resultados actuales en la cirugía de sustitución valvular aórtica en octogenarios. Rev Esp Cardiol. 2012;65:467.

4. Varadarajan P, Kapoor N, Bansal RC, Pai RG. Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: results from a chort of 277 patients aged >80 years. Eur J Cardio-thorac Surg. 2006:722-7.

5. Bach DS. Unoperated patients with severe aortic stenosis. JACC. 2007;50:2018-20.

6. Sanhuenza E. Insuficiencia valvular y anestesia. Rev Chil Anest. 2013;42:67-76.

7. Hindle A. Intrathecal opioids in the management of acute postoperative pain. Contin Educ Anaesth Crit Care Pain. 2008;8:81-5.

8. De Pietri L, Siniscalchi A, Reggiani A, Masetti M, Begliomini B, Gazzi M, et al. The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia. Anesth Analg. 2006;102:1157-63.

9. Gidwani UK, Mohanty B, Chatterjee K. The pulmonary artery catheter: a critical reappraisal. Cardiol Clin. 2013:545-65.

10. Pearse R, Harrison D, McDonald N, Gillies MA, Blunt M, Ackland G, et al. Effect of perioperative, cardiac output-guided hemodynamic therapy algorithm on outcomes following major gastrointestinal surgery. A randomized clinical trial and systematic review. JAMA. 2014;311:2181-90.
How to Cite
1.
Rodríguez-Navarro M Ángeles, Rastrollo-Peña D, Iranzo-Reverter J, Sánchez-Ortega JL, García-Fernández R, Díaz-Alejo C. Hemicolectomy in a patient with aortic valve disease: Case report. Colomb. J. Anesthesiol. [Internet]. 2017Apr.1 [cited 2021May12];45(Supplement):36 -39. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/448

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Published
2017-04-01
How to Cite
1.
Rodríguez-Navarro M Ángeles, Rastrollo-Peña D, Iranzo-Reverter J, Sánchez-Ortega JL, García-Fernández R, Díaz-Alejo C. Hemicolectomy in a patient with aortic valve disease: Case report. Colomb. J. Anesthesiol. [Internet]. 2017Apr.1 [cited 2021May12];45(Supplement):36 -39. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/448
Section
Case Report / Case Series

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