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