Abstract

Anaesthetic management of patients with history of coronary artery bypass grafting(CABG) and acute pulmonary embolism (PE) presents a significant challenge to the Anaesthesiologist.

This report discusses the perioperative challenges in the management of a patient with a complex medical history who required urgent diversion colostomy for subacute intestinal obstruction. The patient was a case of carcinoma rectum with a history of systemic hypertension, diabetes mellitus, dyslipidaemia, chronic deep vein thrombosis (DVT), ischaemic heart disease (IHD) post- CABG and most notably, with added acute PE in the preoperative period. The anaesthetic management was focused on minimizing perioperative risks while managing the patient’s critical conditions. A multidisciplinary approach was employed for the optimisation of the cardiorespiratory function, placement of an Inferior venacava (IVC) filter to prevent further embolic events, anticoagulation therapy, and close monitoring of coagulation parameters. The report reviews the relevant literature and discusses strategies for managing such high-risk patients.

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