Anesthetic management of a patient undergoing cardioverter defibrillator implantation: usefulness of transesophageal echocardiography and near infrared spectroscopy

A case of a patient with sustained ventricular tachycardia (VT) undergoing implantable cardiovertor defibrillator (ICD) implantation, using transesophageal echocardiography (TEE) and near infrared spectroscopy (NIR) is described. A 67-year-old man with sustained VT associated with old myocardial infarction underwent ICD implantation. Anesthesia was induced with fentanyl and propofol and maintained with nitrous oxide, oxygen, sevoflurane, and fentanyl. Global hypokinesis of the left ventricle was observed in the short-axis view provided by TEE. Intraoperative systolic blood pressure was maintained between 100 and 120mmHg, and cerebral oxygenated hemoglobin (HbO2) was between 63% and 65%. During periods of induced ventricular fibrillation, systolic blood pressure decreased to 60mmHg, HbO2 decreased to 59%, and TEE revealed cardiac arrest. These changes were transient; HbO2 returned to baseline values immediately after the restoration of normal rhythm. TEE confirmed no remarkable change in cardiac function after defibrillation testing. TEE and NIR were found to be beneficial for the anesthetic management of a patient with sustained VT who was underdoing ICD implantation.