Abstract

Introduction: Dilated Cardiomyopathy is a syndrome characterized by cardiac enlargement and impaired systolic function of one or both ventricles. A large number of cases are idiopathic. The known causes are ischemic, valve dysfunction and post viral infection. DCM can also be found in association with sickle cell disease, muscular dystrophy, excess alcohol, hypothyroidism and some chemotherapy agents or during peripartum period. Patients with dilated cardiomyopathy are regarded to be of high risk for perioperative complications, necessitating diligent anaesthetic management. Case report: A 2 year old girl child diagnosed with the cellulitis of left upper limb And left foot, with query of osteomyelitis of left elbow joint posted for incision and drainage and wound debridement. Child presented with a history of dilated cardiomyopathy diagnosed at the age of 6 months and was put on medication. 2D echocardiography showed dilated left ventricle with global hypokinesia of left ventricle with sever left ventricular systolic dysfunction, with ejection fraction of 20 percent. On examination wound to have severe anaemia with Hb of 5g%. Through pre-operative cardiovascular stabilisation done by consultation of cardiologist opinion in view of DCM and Paediatrician in view of anaemia. Standard monitoring ensured perioperatively with keen monitoring over cardiovascular status. On the day of surgery, patient Blood Pressure (BP) was 96/60 mm Hg, Heart Rate (HR) was 130/min and oxygen saturation (SaO2) was 100% on room air. Other parameters monitored were ECG, end tidal carbon dioxide and oxygen saturation. anaesthesia was induced slowly with iv ketamine 3.5mg, and iv succinylcholine 7 mg. LMA of size 2 was used. Anaesthesia was maintained with O2/N2O, servoflurane (mac 3.5-1). Surgery was completed in 60 minutes Intraoperatively total IV fluids 60 ml given. At the end of surgery LMA removed and patient was kept in Paediatrics icu for one day for observation Conclusion: As the patient posted for wound debridement with known history of DCM. Hemodynamic management and support was extremely useful to these patients. Due to short procedure, LMA was selected to avoid the post intubation responses. And maintained minimal IV fluids In this case, the anaesthetic management was handled successfully without any consequences. Key Messages: Different types of cardiomyopathy are there of which obstructive cardiomyopathy is more symptomatic. In our patient it was a dilated cardiomyopathy which may present as cardiac failure when the patient is exposed to any stress (surgical or anaesthetic). Anaemia may further worsen the condition. So hemodynamic monitoring and fluid management plays a major role in avoiding complication. We managed this case with meticulous planning, minimal fluids, pain relief and ended up with a successful outcome.

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