Endoscopic Dacryocystorhinostomy in an Elderly Patient With Severe Left Ventricular Dysfunction Under Individualized Monitored Anesthesia Care

Sameer Sethi

doi:10.52916/jcar214009

Abstract

Endoscopic dacryocystorhinostomy is generally performed under general anaesthesia. However, elderly patients with multiple comorbidities can impose significant risk during conduction of general anesthesia. We report safe management of an elderly patient with hypothyroidism and severe left ventricular systolic dysfunction having implantable cardioverter defibrillator planned for endoscopic dacryocystorhinostomy using monitored anesthesia care. Emphasis is given to the specific drug choices and technique of oxygen supplementation along with assisted local anesthesia in this scenario.

Highlights

IntroductionEndoscopic dacryocystorhinostomy (endoDCR) is generally performed under general anaesthesia
Endoscopic dacryocystorhinostomy is generally performed under general anaesthesia
We report safe management of an elderly patient with hypothyroidism and severe left ventricular systolic dysfunction having implantable cardioverter defibrillator planned for endoscopic dacryocystorhinostomy using monitored anesthesia care.Emphasis is given to the specific drug choices and technique of oxygen supplementation along with assisted local anesthesia in this scenario

Summary

Introduction

Endoscopic dacryocystorhinostomy (endoDCR) is generally performed under general anaesthesia. We report safe management of an elderly patient with hypothyroidism and severe left ventricular systolic dysfunction having Implantable Cardioverter Defibrillator (ICD) planned for endoDCR using Monitored Anesthesia Care (MAC) [individualized drug choices and technique of oxygen supplementation] with assisted local anesthesia. Patient was receiving amiodarone 100 mg OD,aspirin 150 mg OD, dabigatran 110 mg OD and metoprolol 50 mg OD orally He was detected having hypothyroidism since 5 months and was on tablet levothyroxine 125 μg OD. Patient was advised to continue tablets levothyroxine 125 mcg OD, amiodarone 100 mg OD and metoprolol 50 mg OD even on the day of surgery He was kept nil per oral for 8 hrs for solids, 2 hrs for clear fluids. J Clin Anesthes Res, Citation: Sethi S, Gandhi KA, Mahajan V (2021) Endoscopic Dacryocystorhinostomy in an Elderly Patient With Severe Left Ventricular Dysfunction Under Individualized Monitored Anesthesia Care.

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