Anaesthetic management of colorectal surgery in a patient with chronic pericardial effusion (2025)

Type of publication:

Journal article

Author(s):

*Ahmad, E; *Liu, H S; *Miller, A.

Citation:

Anaesthesia Reports. 13(2):e70031, 2025 Jul-Dec.

Abstract:

Chronic pericardial effusions are a peri-operative challenge as anaesthesia and surgery can precipitate haemodynamic compromise. Guidance for managing patients requiring time-sensitive non-cardiac surgery in this setting is limited. We report the case of a 43-year-old woman with a moderate chronic, asymptomatic pericardial effusion scheduled for robotic anterior resection of rectal cancer. The principal challenge was balancing the need for time-sensitive oncological surgery against the risk of haemodynamic compromise in the context of suboptimal pre-operative cardiology assessment. Surgery proceeded after multidisciplinary discussion, with pre-emptive vasopressor support and intra-operative transoesophageal echocardiography monitoring to guide management. The peri-operative course was stable, and the patient was discharged on postoperative day 4. Two months later, she required pericardial window formation for a persistent effusion which had become symptomatic. This case illustrates that non-cardiac surgery in chronic, asymptomatic pericardial effusion can be performed safely when guided by physiological reasoning, real-time echocardiography and multidisciplinary planning.

DOI: 10.1002/anr3.70031

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