The patient was an 81-year-old man with oral floor cancer and severe aortic stenosis (AS). The patient was scheduled to undergo an oral floor cancer excision, neck dissection, and forearm flap reconstruction under general anesthesia.
Severe AS, which is a major perioperative risk factor in non-cardiac surgery and is responsible for a predisposition to hemodynamic disruption during perioperative surgery, has a 10% risk of perioperative mortality. A preoperative examination revealed an exacerbation of the aortic stenosis, and long-term surgery was considered to be difficult. After consulting with oral surgeons, cardiologists, and the patient, a decision was made to perform oral surgery after improving the AS using a transcatheter aortic valve implantation (TAVI) procedure.
Under the supervision of the Department of Medical Anesthesiology, a balloon-dilated valve was placed under general anesthesia using a transfemoral artery approach. No postoperative heart failure was observed, and the patient’s progress was good, as shown by an evaluation of cardiac function after the TAVI. Therefore, the patient underwent oral surgery 34 days after the TAVI. General anesthesia was maintained with air-oxygen-sevoflurane and the intravenous administration of remifentanil, fentanyl and ketamine. During the operation, the patient’s blood pressure was maintained with an intravenous infusion of phenylephrine, dopamine and noradrenaline, and no significant episodes occurred. After the operation, he was managed in the ICU. Antithrombotic treatment was started 7 days after the oral surgery. The patient was discharged 36 days after the oral surgery (70 days after the TAVI).
Here, we describe the long-term general anesthesia management of a patient with oral floor cancer who had recently undergone a TAVI. For patients with severe AS complications, safe perioperative management can be achieved by examining surgical applications and surgical procedures across multiple departments.
