ABSTRACT: Introduction: Administering anaesthesia to patients with pre-exist¬ing cardiac disease is a challenge. Most com¬mon cause of peri-operative morbidity and mortality in cardiac patients is ischaemic heart disease (IHD) ,most of them occur within 72 hours post-operatively. So proper anaesthetic management of these pa¬tients require identification of risk factors, pre-operative evaluation & optimization, medical therapy, monitoring and the choice of appropriate anaesthetic technique and drugs.

METHODS : Case review: A 36 years old female diagnosed as ruptured ectopic pregnancy presented with BP 90/60 mm Hg ,HR-116 bpm. Hb - 7.6 gm%. On ECG anterolateral ischemic changes were found but enzyme assay was negative suggestive of old M.I. Following resuscitation with RL solution & 2 units blood vitals were found to be stable & emergency laparotomy was performed under epidural anaesthesia.Pulse,SPO2, ECG, urine output ,central venous pressure & invasive blood pressure were monitored continuously. Hemodynamic parameters were maintained for whole intraoperative period along with nitroglycerine infusion 0.2µg/kg/min to maintain myocardial perfusion. Surgery was done successfully &patient shifted to ICU.

RESULTS : With epidural anaesthesia stress response associated with G.A can be avoided .Post operative pain which may evoke further ischaemia is better managed with epidural anaesthesia

CONCLUSIONS : Successful perioperative evaluation and management of high-risk cardiac patients undergoing non-cardiac surgery requires careful teamwork and communication between cardiologist, surgeon & anaesthesiologist.