Anesthesia management of Intra-operative myocardial infarction in a patient posted for emergency spine surgery: A case report

Abstract

Aim: To understand the anesthesia management in a case of an adverse cardiac outcome intra-operativelyBackground: Peri-operative Myocardial Infarction (PMI) is associated with a very high rate of morbidity and mortality, especially in patients posted for high-risk surgery with unknown cardiac status. We report a case of acute myocardial infarction in a patient without cardiac risk factors during decompression and instrumentation of spine. Case Description: A 49-year-old, 58 kg and 178 cm man, with a raised blood pressure of 160/100 mm Hg, with no previous history of hypertension or cardiovascular diseases was posted for Emergency Decompression and Instrumentation surgery. Intra-operatively, patient developed sudden hypotension and ST segment elevation which was corrected with intravenous fluids, packed red cell, DAPT and anticoagulants. Patient improved clinically within 2 weeks and was discharged without complications.Conclusion: Peri-operative Myocardial Infarction (PMI) requires close monitoring, prompt detection, correction of hemodynamics and team effort. Clinical Significance: To outweigh the benefits of conducting a high-risk surgery in a patient with uncontrolled hypertension, to initiate timely symptomatic therapy, administering drugs that will maintain the coronary blood flow and giving definitive measures for the same.