HOCM: halothane mgmt
Pretest
True or false
A thirty-five year old male was admitted with atypical chest pain for last one year.
X-ray chest revealed cardiomegaly (CT ratio 0.6).
Electrocardiographic findings were left axis deviation with left ventricular hypertrophy. On echocardiography, there was moderate mitral regurgitation (MR), systolic anterior motion (SAM) of anterior mitral leaflet and prominent systolic narrowing of left ventricle cavity.
Transoesophageal echocardiography (TOE) also showed an anomalous muscle bundle stretching into LV causing obstruction. Preload was kept high. Systemic vascular resistance (SVR) was maintained, avoiding use of vasodilators and inotropes.
Morrow’s septal myectomy was done. Anomalous muscle bundle was excised.
On postoperative TOE, there was no MR and no obstruction.
Optimal anaesthetic management in such patients involves maintaining adequate preload, systemic vascular resistance and minimal outflow obstruction.
Other considerations are to maintain haemodynamic stability, sinus rhythm and afterload.
Question 1
True or false
1. Transoesophageal echocardiography is an extremely useful monitoring device in such patients.
2. Transoesophageal echocardiography (TOE) show an anomalous muscle bundle.
3. Preload should be kept high.
4. Systemic vascular resistance (SVR) should maintained
Answer
TTTT