ANAESTHETIC MANAGEMENT OF A PATIENT WITH RHEUMATIC VALVULAR HEART DISEASE POSTED FOR FIXATION OF ACETABULUM FRACTURE

Abstract

Patients with rheumatic heart disease (RHD) undergoing non-cardiac surgeries present a challenge for anesthesiologists. This case report discusses the anesthetic management of a 56-year-old female with severe mitral stenosis, posted for acetabulum fracture xation. The patient's history revealed RHD with severe mitral stenosis, mild mitral regurgitation, and severe pulmonary hypertension. Considering the risks associated with neuraxial anesthesia in mitral stenosis, general anesthesia (GA) with a Pericapsular Nerve Group (PENG) block was chosen. The patient was carefully premedicated, induced with appropriate drugs, and monitored intraoperatively. The PENG block, performed under ultrasound guidance, aimed to reduce hip pain without causing motor blockade. The patient remained hemodynamically stable throughout the surgery, and postoperatively, the combination of GA with PENG block provided effective pain control, reducing the need for opioids. This approach contributed to an early recovery, emphasizing the importance of tailored anesthesia strategies for valvular heart disease patients undergoing non-cardiac surgeries.