Abstract
A 70-year-old man with a past history of myocardial infarction was scheduled for transurethral resection of bladder tumor. He had undergone percutaneous coronary intervention 107 days before the surgery with a bare metal stent placed at #4 atrioventricular nodal branch (#4AV) of the right coronary artery. The cardiologist as well as the anesthesiologist preoperatively evaluated the cardiac function of the patient as normal, and the surgery was performed under general anesthesia. The patient was extubated after full recovery from the general anesthesia lasting for 45 minutes, but he immediately developed hypoxemia and was reintubated. Echocardiography and chest radiograph revealed acute heart failure associated with pulmonary edema. He was admitted to our CCU, where he was mechanically ventilated and was supported with catecholamines and coronary dilators. He responded well to the treatment and was discharged from the CCU on the 24th postoperative day. A close review of his preoperative serial tests including plasma brain natriuretic peptide measurements and electrocardiograms revealed that another ischemic event might have occurred within 3 weeks before the surgery, resulting in deterioration of his cardiac function, which had been undetectable during preoperative physical examination. A patient with deteriorating cardiac function may be at high risk of developing decompensated heart failure even after a short period of general anesthesia. Detailed preoperative cardiovascular evaluation as well as careful anesthetic management is crucial to safer managements of cardiac patients for non-cardiac surgery.
