Robotic Surgery, Hypertrophic Cardiomyopathy and Difficult Airway – A Challenging Combination for the Anesthesiologist! : A Case Report

摘要

The introduction of robotic surgery has heralded new challenges for the anesthesiologists. The daVinci TM robotic system provides a three-dimensional view and better work ergonomics for the surgeon, especially in complex and radical cancer surgeries. Innovation of robotic surgery has opened the doors for newer concerns in patient safety for the anesthesia team. This is of greater importance in patients with concurrent serious conditions like hypertrophic cardiomyopathy. The challenge becomes greater when difficult airway compounds the situation. Keyword Robotic, Hypertrophic cardiomyopathy, Anesthesia, Difficult airway routine follow up for carcinoma larynx on PET-CT scan (Positron Emission Tomography), as he was asymptomatic otherwise. He was a known case of hypertension, on regular treatment since 12 years. He was also diagnosed to have hypothyroidism after radiotherapy to the neck and was on regular thyroxine replacement therapy since then. Most importantly, he was a diagnosed case of hypertrophic cardiomyopathy, which presented with history of 2 consecutive episodes of stable angina 12 years back. His angiographic study showed normal coronaries. His current echocardiographic findings revealed asymmetric septal hypertrophy with left ventricular ejection fraction (LVEF) of 67%, concentric left ventricular hypertrophy and no regional wall motion abnormalities. He was on thyroxine supplementation (Thyronorm 100mcg daily), aspirin 75mg daily and betablocker therapy (Tab Metoprolol 25 mg once daily). ECG showed sinus bradycardia with T wave inversion in all chest leads. On functional cardiac assessment, his effort tolerance was good (Metabolic equivalents >4). He was a reformed chronic smoker and tobacco chewer, which he quit after diagnosis of carcinoma larynx. During routine pre-anesthetic evaluation, all his blood investigation results were normal, including serum electrolytes, thyroid function tests, renal function tests and coagulation profile. Chest X-ray was also within normal limits. All his medications were continued till morning of the surgery.