Metrics details. In the surgical population, comorbidities, aging, and frailty are increasingly prevalent [1]. The decision to operate was sometimes challenging due to the difficult balancing of risks versus benefits. Many efforts are undertaken in order to minimize anesthesiological and surgical impact on physiological status and so to reduce perioperative complications. A year-old man, with Marfan syndrome and severe dilatative cardiomyopathy, received a heart transplant in ; he presented also recurrent episodes of pneumothorax, ischemic strokes without severe sequelae and chronic renal failure CRF.
In , he was diagnosed with colon cancer necessitating right hemicolectomy. Among the issues was altered autonomic physiology due to donor heart denervation, resulting in preload-dependent heart [2]. Risks included also infectious complications due to immunomodulatory therapy, pneumothorax during mechanical ventilation, metabolic complications due to CRF.
Following a multidisciplinary evaluation to explore strategies to minimize perioperative risk, we decided to perform neuraxial anesthesia in spontaneous breathing. Preoperatively, the patient was prepared according to the local ERAS protocol. Intraoperatively, standard monitoring ECG, SpO2 , invasive arterial pressure, semi-invasive cardiac monitoring proAqt , BIS, capnography, and temperature sensor were applied. Segmental spinal anesthesia was performed at T9-T10 with levobupivacaine 0.
Written informed consent was obtained with special regard to off-label intrathecal dexmedetomidine use. As expected, because of orthosympatic block, secondary to thoracic spinal anesthesia, hypotension occurred immediately post-intrathecal injection, promptly treated with noradrenaline infusion maintained throughout the procedure maximum dose 0.
The laparoscopic procedure lasted two hours without issues, with good surgical maneuverability according to the surgeon's opinion. Postoperative analgesia was ensured by 0. Cautionary hospitalization in intensive care setting was mantained for 24 h. Postoperative period was uneventful without medical or surgical complications.
