Anesthesia Techniques for Surgical Treatment of Tuberculous Constrictive Pericarditis

For the surgical management of tuberculous constrictive pericarditis, general anesthesia using either intravenous or combined intravenous-inhalational techniques is typically employed. Prior to anesthesia induction, it is crucial to assess the patient's overall health status, nutritional condition, and specific characteristics associated with constrictive pericarditis. Patients suffering from this condition often experience significant fibrosis and thickening of the pericardium, which leads to external compression of the heart and impairs both systolic and diastolic cardiac function—particularly affecting the heart's ability to relax properly. As a result, patients may present with tachycardia, dyspnea, or other signs of heart failure.

Monitoring and Preoperative Considerations

In addition to standard monitoring parameters such as electrocardiogram (ECG), non-invasive blood pressure, and pulse oximetry, invasive monitoring is usually required. This includes radial artery cannulation for continuous blood pressure monitoring and central venous access to facilitate fluid and medication administration. These measures allow for more precise hemodynamic control throughout the procedure.

Anesthetic Management During Induction

During anesthesia induction, particular attention must be paid to drug selection to prevent myocardial depression and excessive vasodilation. The use of sedatives must be carefully titrated to maintain adequate cardiac output. A common approach involves administering high-dose opioid agents like fentanyl to provide hemodynamic stability while minimizing the risk of myocardial depression. Simultaneously, neuromuscular blocking agents are given to ensure optimal surgical conditions and proper intubation.

Intraoperative Challenges and Interventions

Maintaining a relatively fast heart rate is essential to prevent hypotension and ensure adequate perfusion. Bradycardia should be avoided as it may lead to systemic vasodilation and further compromise cardiac output. In cases of intraoperative hypotension, vasopressors are often required to maintain mean arterial pressure within an acceptable range.

Furthermore, due to the complexity of the procedure—often involving sternotomy and meticulous pericardial dissection—there is a significant risk of intraoperative bleeding or inadvertent cardiac injury. The surgical team must be prepared for potential cardiac rupture during dissection, requiring immediate administration of cardioprotective agents and emergency interventions as necessary.

Collaborative Perioperative Care

Anesthesia for this type of cardiac surgery should be managed similarly to other complex cardiac procedures. Close communication between the anesthesiologist and the cardiac surgical team is vital throughout the perioperative period to ensure patient safety and optimize outcomes. This collaborative approach allows for real-time adjustments in anesthetic depth, hemodynamic support, and overall patient management.