Ischaemic cardiomyopathy with low ejection fraction (EF) poses a perioperative challenge to the anesthetist due to the risk of hemodynamic instability, cardiovascular collapse, and heart failure. More so when a patient has an Automated Implantable Cardiovertor Defibrillator (AICD) in situ. We report the anesthetic management of a patient with ischaemic cardiomyopathy with an EF of 20% and AICD in situ posted for open right hemicolectomy. Dynamic hemodynamic monitoring with preparedness to manage fluid shifts, hemodynamic fluctuations, and adequate pain management is essential to successful anesthetic management in patients with an AICD, where programming is not possible.
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