PCI under General Anaesthesia

PIG Meeting: 29th April 2021

Elective PCI in a man with known triple vessel disease.

Background

  • Wheelchair-bound man with muscular dystrophy
  • Uses BiPAP at home – for sleep and occasionally daytime (Pressures 19/12cmH20)
  • Proceduralist has booked for GA

Issues

  • Unable to lie flat, sleeps sitting upright at home. Consideration of ischaemic heart disease contributing to SOB.
  • Requires BiPAP if sleeping
  • Muscular dystrophy
  • Known TVD, Previous PCI with cardiologists only – stented 2 of the 3 vessels. Now proceeding to the third blocked vessel.

Discussion

  • Anaesthetic options discussed
  • BiPAP required at home, can we administer additional Oxygen via patients own machine?
  • Could use HFNP but unlikely to provide enough support given significant pressure on own machine
  • Option to borrow a BiPAP machine from ICU
  • Consensus that avoidance of a GA in this patient would be preferable
  • Uncertain about type of muscular dystrophy but would avoid use of depolarising muscle relaxants

Plan

  • Discuss with proceduralist, option for light sedation/no sedation in as elevated position as possible
  • BiPAP machine from ICU if needing supplemental O2, consider using own if no O2
  • Need some more information on muscular dystrophy and any issues with previous procedure

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