ABSTRACT : Anaesthetic management in a patient with pre-existing cardiac disease is a challenge. Most common cause of Peri-operative morbidity and mortality in a cardiac patient is Ischemic Heart Disease (IHD). Care of these patients requires identification of risk factors, Peri-operative evaluation and optimization, medical therapy, monitoring and choice of appropriate anaesthetic technique and drugs. Peri operative morbidity and mortality depends upon various clinical risk factors and surgery- specific risk factors. Anaesthetic goals remain, 1) Stable Hemodynamics 2) Prevention of Myocardial ischemia 3) Monitoring 4 ) Appropriate interventions if ischemia/infarction develops 5) Normothermia 6) Maintenance of Haematocrit.

METHODS : Hereby we are sharing our experience of Anaesthetic management in a 53 year old female patient with IHD/ Post-PTCA status(Percutaneous Transluminal Coronary Angioplasty) with reduced Left ventricular function with ejection fraction of 38%,who was accepted under ASA-4(American Society of Anaesthesiologists) for ParaumbilicalHernioplasty surgery.

RESULTS : With patient being on polypharmacy since PTCA, Clopidogrel was stopped 5 days prior to surgery and Tab.Ecospirin75mg was continued. Surgery was done under General Anaesthesia using Propofol/Vecuronium/Buprenorphine/Oxygen/Nitrous Oxide/Sevoflurane . Monitoring of ECG,NIBP,SPO2,HR,Temperature,EtCo2 was done intraoperatively. Reversal with Neostigmine &Glycopyrrolate.Extubation was smooth.The conduct of anaesthesia & Course of surgery were uneventful.

CONCLUSIONS : The choice of anaesthesia for a patient with IHD for non cardiac surgery should fulfil the objective of minimising demand and optimum supply of oxygen. With multiple anaesthetic options available,General anaesthesia still offers the best choice, by having a better control over hemodynamics.