Anesthetic management of laparoscopy-assisted total proctocolectomy in a cardiac sarcoidosis patient with a cardiac resynchronization therapy-defibrillator: a case report

Abstract

Background: Cardiac sarcoidosis (CS) causes severe conduction abnormalities and arrhythmias. CS patients are increasingly being treated with cardiac resynchronization therapy-defibrillators (CRT-Ds). For the first time, we report the anesthetic management of a CS patient with a CRT-D.

Case presentation: A 65-year-old male with an implanted CRT-D due to CS was scheduled for a laparoscopy-assisted total proctocolectomy for his transverse colon cancer. His left ventricular ejection fraction was 32.0%, and his physical status was a New York Heart Association class III. General and epidural anesthesia were performed while using standard monitors and a FloTrac^TM system. The dual-chamber pacing (DDD) modality of the CRT-D was unchanged, and its defibrillation function was deactivated before surgery. The surgery was successfully performed, and the patient was discharged without worsening of his cardiac condition.

Conclusions: A detailed understanding of this patient's condition, as well as sarcoidosis, helped to facilitate successful anesthetic management of this patient.

Keywords: Anesthetic management; CRT-D; Cardiac sarcoidosis.

Fig. 1

Abnormal thinning of the basal ventricular septum. A parasternal long-axis transthoracic echocardiography view at the level of the aortic valve showing abnormal ventricular septal thinning with a minimal thickness of 4.4 mm (arrow). LA left atrium, LV left ventricle, RA right atrium, RV right ventricle, Ao aorta

Fig. 2

Anesthesia record of a patient with cardiac sarcoidosis who underwent laparoscopy-assisted total proctocolectomy. DOA dopamine, BP blood pressure, SVV stroke volume variation, CI cardiac index, ScvO₂ central venous oxygen saturation, SVR systemic vascular resistance