Anesthetic challenges in a cardiac patient undergoing noncardiac surgery

Abstract

We report a case of a patient with coronary artery disease (ejection fraction [EF] = 20%) with automatic implantable cardioverter-defibrillator (AICD) implanted, hypertension, diabetes mellitus, chronic kidney disease, and peripheral vascular disease for vitrectomy. This patient was diagnosed as a case of bilateral retinal detachment with proliferative vitreoretinopathy Grade III. He developed hyphema in the right eye due to long-standing uncontrolled diabetes with complete loss of vision. This case was very complex to manage as the patient had comorbidities with low EF. The case was done on an urgent basis thinking that the patient might lose eyesight if he is not operated quickly. A 55-year-old male presented with complaints of breathlessness, chest discomfort, and cough and diagnosed as left ventricular failure with cardiogenic shock. He complained of sudden onset loss of vision after 2 days of admission while in Intensive Care Unit. This patient had vitreous hemorrhage due to end-stage diabetic disease. The patient was suffering from triple vessel coronary artery disease (EF = 20%, regional wall motion abnormalities), AICD in situ, diabetes, hypertension since 10 years, and peripheral vascular disease with peripheral plasty. He was a chronic alcoholic and smoker as well. His renal function tests showed serum creatinine 1.8 mg/dl. Patient was planned for right eye vitrectomy to save vision. The patient was operated without any complications.