Anaesthetic Management of Patient with Left Atrial Myxoma, Coronary Artery Disease 3 Vessels Disease, and Parkinsons Disease
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Date
2024-01-09
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Abstract
Myxomas are the most common primary benign intracavitatory tumour with the incidence of 0.5 per million
populations. Myxomas account for 0.3% of all cardiac surgeries performed. Clinically, they are characterized by
a triad of embolisation, obstruction of blood flow, and constitutional symptoms (Goodwin’s triad). Meanwhile
Parkinson`s disease is a degenerative neurologic disorder caused by degeneration of nerve cells in the substantia
nigra causing weakness motor coordination. Symptoms include tremor, bradykinesia, rigidity, and postural
instability. Achieving a satisfactory hemodynamic performance is the primary objective in the management of
cardiac surgery patient. Optimal cardiac function ensures adequate perfusion and oxygenation of other organ
systems (in particular vital organs) and improves the chances for an uneventful recovery from surgery. A 61-year
old female diagnosed with Coronary Artery Disease 3 Vessel Disease (CAD 3 VD), Parkinson’s disease, and left
atrial myxoma was brought to the emergency department with dyspnea. The patient has undergone angiography
and the echocardiography result was LVEF 59% with global normokinetic, LA myxoma causing non-significant
mitral flow. LA myxoma excision under general anaesthesia on CPB was planned. Balanced general anaesthesia
on cardiopulmonary bypass forms the basis of Anaesthetic management of Cardiac myxomas. However specific
individual considerations will have to be made regarding drugs, doses, regional anaesthetic choices,
anticoagulation and post-operative management. There is no simple anesthetic technique for patients with
Parkinson’. Therefore, careful preoperative assessment, administration of drugs during and after anesthesia, as
well as avoiding agents that are known to trigger Parkinson`s symptoms is a major factor in reducing postoperative
morbidity and mortality.
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Anesthetic Management, CAD 3VD, Cardiopulmonary Bypass