Postoperative pulmonary edema following vitrectomy in patients with ischemic heart disease and diastolic dysfunction in the post-anesthetic care unit

Abstract

Rationale: The increasing incidence of cardiac comorbidities in the elderly population has led to an increasing demand for vigilance of cardiac dysfunction induced by surgery. Favorable outcomes can be ensured in such cases by an increased awareness of cardiogenic complications, early identification of the problem, and appropriate treatment. Patient concerns: This study presents 2 cases of acute pulmonary edema (PE) that were likely caused by ischemic heart disease and diastolic dysfunction in postoperative patients, following vitrectomy, in the post-anesthetic care unit. Diagnoses: Chest x-ray and computed tomography indicated PE. Interventions: Following the diagnosis of PE, patients were intubated and transferred to the intensive care unit where 20 mg furosemide was injected and 10 μg/kg/min dobutamine was infused intravenously. Outcomes: On postoperative day 2, the patients’ vital signs were stable and there were no signs of respiratory disturbance. Lessons: Physicians should be alert to the potential development of PE as a postoperative complication in patients with left ventricular (LV) diastolic dysfunction and ischemic heart disease, even if the patient has undergone a procedure with mild hemodynamic change and minimal surgical stimulation such as vitrectomy. We propose that physicians treating elderly patients with LV diastolic dysfunction and ischemic heart disease undergoing vitrectomy should consider the use of intraoperative transthoracic echocardiogram or transesophageal echocardiogram with continuous monitoring of blood pressure, using devices such as arterial catheter devices.

Assessment of Patients Whose Pars Plana Vitrectomy Operations Were Postponed in the Operating Room: Retrospective Study

“…According to the studies in the literature, operations were delayed until blood pressure and heart rhythm reached a stable state due to the high risk of postoperative systemic side effects in these patient groups. 24,26,27 Besides the success of surgical results, the time efficiency of the operating room has received great attention in the recent literature. 28,29 Postponement of the surgery causes both financial and time loss.…”

A Case Report Total Intravenous Anesthesia Combined with Peribulbar Block in Vitrectomy Operation with Heart Disorder

“…The majority of anesthetic Technique general anesthesia is performed on patients who cannot coordinate. 7 The use of combination anesthetic techniques in eye surgery has been carried out in various studies. This combined anesthetic technique was also found to be more advantageous than vitrectomy surgery with only one anesthetic technique.…”

“…However, in light of the result of the present cases, perioperative cardiovascular evaluations and monitoring are needed even for patients undergoing hemodynamically stable surgeries with relatively short operation times, such as vitrectomy. 7 Block anesthetic techniques and local anesthetics have relatively mild cardiovascular or pulmonary side effects when compared to general anesthesia. The advantages of regional anesthesia over general anesthesia include better antiinflammatory effects (lower stress response) and lower cardiopulmonary effects.…”