CASE REPORT
ANAESTHETIC MANAGEMENT FOR TOTAL GASTRECTOMY IN A PATIENT WITH PREVIOUS ASCENDING AORTIC DISSECTION REPAIR: A CASE REPORT

UDK: 616.33-006.6-089.87

Etemi S.R1, Mechkaroska R2, Kostovski O3, Chavkoska M4

 

1 University Clinic for Traumatology, Orthopedic Diseases, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Clinical Center “Mother Theresa”, Skopje, Republic of North Macedonia2

2 Department of Anesthesiology and Intensive Care, General Hospital Struga, Republic of North Macedonia

3 University Clinic for Digestive Surgery, Clinical Center “Mother Theresa”, Skopje, Republic of North Macedonia

4 Department of Anesthesiology and Intensive Care, General Hospital Ohrid, Republic of North Macedonia

 

Abstract

Introduction: Total gastrectomy remains the gold standard for gastric adenocarcinoma treatment. The procedure poses significant anesthetic challenges due to its complexity and the physiological stress associated with major abdominal surgery. These challenges are further amplified in patients with a history of other diseases, especially those affecting the cardiovascular system, who require careful hemodynamic management and tailored perioperative strategies in the operating room. Case Presentation: This case report presents the perioperative management of a 62-year-old male diagnosed with gastric adenocarcinoma who underwent total gastrectomy. The patient had undergone surgical repair of an ascending aortic dissection three years earlier. Preoperative transthoracic echocardiography was obtained to assess cardiac function and graft integrity. Anesthetic induction was performed with carefully titrated agents to maintain hemodynamic stability. Invasive arterial blood pressure monitoring was employed throughout the procedure to allow real-time hemodynamic management. Analgesia was provided via a thoracic epidural catheter, with a continuous infusion of low-concentration bupivacaine (0.125%) administered to minimize sympathetic blockade and maintain stable blood pressure. The patient reported minimal discomfort and did not require additional analgesics during the recovery period. He was discharged in good general condition on postoperative day eight.

Conclusion: Patients with prior ascending aortic dissection repair undergoing major abdominal surgery pose significant anesthetic challenges. With appropriate monitoring and individualized management, good outcomes can be achieved.

 

Key words: anesthesia challenging, ascending aortic dissection repair, high risk surgery, total gastrectomy.

 

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