Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma
An elderly woman with preinvasive breast cancer, atrial fibrillation, coronary artery-pulmonary artery fistula, pulmonary hypertension and Stage 4 diabetic nephropathy underwent a mastectomy and sentinel lymph node biopsy. Managing her perioperative fluid balance and anticoagulation treatment were c...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Penerbit Universiti Kebangsaan Malaysia
2023
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| Online Access: | http://journalarticle.ukm.my/22600/ http://journalarticle.ukm.my/22600/1/m%26h_24.pdf |
| _version_ | 1848815639514316800 |
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| author | ZQ, Lee A, Norlia SM, Syarifah Noor Nazihah KL, Tan |
| author_facet | ZQ, Lee A, Norlia SM, Syarifah Noor Nazihah KL, Tan |
| author_sort | ZQ, Lee |
| building | UKM Institutional Repository |
| collection | Online Access |
| description | An elderly woman with preinvasive breast cancer, atrial fibrillation, coronary artery-pulmonary artery fistula, pulmonary hypertension and Stage 4 diabetic nephropathy underwent a mastectomy and sentinel lymph node biopsy. Managing her perioperative fluid balance and anticoagulation treatment were challenging. Having a malignancy, atrial fibrillation plus underhydration will increase her risk of hypercoagulation. However, fluid overload will lead to pulmonary oedema which will decrease her oxygenation further in pulmonary hypertension. Cessation of anticoagulation also increased the risk of hypercoagulation. Anticoagulant therapy increases the risk of a perioperative wound haematoma, which may require another general anaesthesia for identification and arrest of the bleeding source and haematoma evacuation. A haematoma will also increase the risk of surgical site infection; especially as a diabetic. Her anticoagulant therapy (rivoroxaban) was stopped four days preoperatively. Her ejection fraction was 50%, with Grade II diastolic dysfunction and TAPSE 0.6 cm. Her CHA2DS2-VASc Score was 5. Perioperatively, intraarterial cannulation was connected to the FloTrac™ sensor and EV1000™ monitor. Her fluid management was monitored using goal directed (GD) fluid therapy. The patient underwent surgery successfully and her anticoagulant therapy was recommenced 14 days postoperatively. |
| first_indexed | 2025-11-15T00:53:11Z |
| format | Article |
| id | oai:generic.eprints.org:22600 |
| institution | Universiti Kebangasaan Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-15T00:53:11Z |
| publishDate | 2023 |
| publisher | Penerbit Universiti Kebangsaan Malaysia |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | oai:generic.eprints.org:226002023-11-30T07:23:46Z http://journalarticle.ukm.my/22600/ Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma ZQ, Lee A, Norlia SM, Syarifah Noor Nazihah KL, Tan An elderly woman with preinvasive breast cancer, atrial fibrillation, coronary artery-pulmonary artery fistula, pulmonary hypertension and Stage 4 diabetic nephropathy underwent a mastectomy and sentinel lymph node biopsy. Managing her perioperative fluid balance and anticoagulation treatment were challenging. Having a malignancy, atrial fibrillation plus underhydration will increase her risk of hypercoagulation. However, fluid overload will lead to pulmonary oedema which will decrease her oxygenation further in pulmonary hypertension. Cessation of anticoagulation also increased the risk of hypercoagulation. Anticoagulant therapy increases the risk of a perioperative wound haematoma, which may require another general anaesthesia for identification and arrest of the bleeding source and haematoma evacuation. A haematoma will also increase the risk of surgical site infection; especially as a diabetic. Her anticoagulant therapy (rivoroxaban) was stopped four days preoperatively. Her ejection fraction was 50%, with Grade II diastolic dysfunction and TAPSE 0.6 cm. Her CHA2DS2-VASc Score was 5. Perioperatively, intraarterial cannulation was connected to the FloTrac™ sensor and EV1000™ monitor. Her fluid management was monitored using goal directed (GD) fluid therapy. The patient underwent surgery successfully and her anticoagulant therapy was recommenced 14 days postoperatively. Penerbit Universiti Kebangsaan Malaysia 2023 Article PeerReviewed application/pdf en http://journalarticle.ukm.my/22600/1/m%26h_24.pdf ZQ, Lee and A, Norlia and SM, Syarifah Noor Nazihah and KL, Tan (2023) Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma. Medicine & Health, 18 (1). pp. 272-278. ISSN 2289-5728 https://www.medicineandhealthukm.com/toc/18/1 |
| spellingShingle | ZQ, Lee A, Norlia SM, Syarifah Noor Nazihah KL, Tan Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma |
| title | Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma |
| title_full | Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma |
| title_fullStr | Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma |
| title_full_unstemmed | Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma |
| title_short | Challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma |
| title_sort | challenges in perioperative fluid management and anticoagulant therapy in a woman with cardio-pulmonary-renal disease diagnosed with preinvasive breast carcinoma |
| url | http://journalarticle.ukm.my/22600/ http://journalarticle.ukm.my/22600/ http://journalarticle.ukm.my/22600/1/m%26h_24.pdf |