When Cardiomyopathy Meets Nephrolithiasis: Tailored Anaesthesia in Dilated Cardiomyopathy for Renal Surgery

Abstract

Background: Dilated cardiomyopathy presents significant challenges due to impaired ventricular function, risk of perioperative decompensation, and sensitivity to fluids and anesthetic agents. Percutaneous nephrolithotomy (PCNL) further increases physiological stress through prone positioning, potential blood loss, and fluctuations in preload. Case Presentation: We report the anesthetic management of a middle aged male patient with known dilated cardiomyopathy (ejection fraction 15%) scheduled for elective PCNL. Preoperative optimization included continuation of guideline – directed medical therapy and meticulous cardiovascular evaluation. Intraoperative management focused on maintaining hemodynamic stability using a balanced anesthetic technique, invasive blood pressure monitoring, ultrasound guided central venous access and goal directed fluid therapy. Induction was achieved with cardio – stable agents, and ventilation was adjusted to avoid increases in pulmonary vascular resistance. The prone position was carefully executed with continuous vigilance on cardiac performance. The surgery proceeded uneventfully with stable hemodynamics throughout. Postoperatively, the patient was monitored in a high – dependency unit and recovered without complications. Conclusion: PCNL in patients with DCM can be safely performed with meticulous perioperative planning. Judicious choice of anesthetic agents, vigilant hemodynamic monitoring, and goal directed fluid therapy. The case highlights the importance of a individualized, physiology based anesthetic approach to minimize perioperative risk in patients with severe cardiac dysfunction.