Anesthetic Management with Total Intravenous Anesthesia for a Patient with Previous History of Acute Myocarditis

Myocarditis is often self-limited and without sequelae, most commonly the result of the viral infection. Recently it has been pointed out that there are some cases of myocarditis progressing to a chronic phase like dilated cardiomyopathy. Worsening congestive heart failure and findings of new electrocardiographic changes are the most catastrophic, sometimes fatal, perioperative events. We experienced a case of a 45-year-old woman with previous history of idiopathic acute cardiomyopathy for non-cardiac surgery. For electrocardiogram monitoring, a five-lead system to detect the intraoperative ischemic events was used to detect frequent ST-T-wave abnormalities. Reducing cardiac irritability and preventing infection are the main points for this anesthetic management. We gave general anesthesia, not combining with epidural anesthesia, to avoid epidural abscess which may cause recurrence of myocarditis. We employed total intravenous anesthesia (TIVA) technique using propofol administration with TCI system and repetitive fentanyl injections. Propofol target concentration was titrated according to bispectral index (BIS) between 40-60. The patient emerged quite well within 20 minutes after discontinuing propofol. We could maintain hemodynamics stably and no severe adverse effects were observed perioperatively. Thus this anesthesia technique was safe and useful to maintain the hemodynamics stably in the case with previous history of idiopathic acute cardiomyopathy.