Anaesthetic Management of a Patient with Dilated Cardiomyopathy Undergoing Ureteroscopic Lithotripsy: A Case Report

Patients with severely compromised left ventricular systolic function undergoing non cardiac surgery present a significant anaesthetic challenge, particularly when the Ejection Fraction (EF) is critically low. Dilated Cardiomyopathy (DCM), characterised by progressive ventricular dilation and impaired myocardial contractility, increases the risk of perioperative instability, arrhythmias and postoperative decompensation. The present case involves a 65-year-old female with long-standing hypertension and Type 2 Diabetes Mellitus (T2DM), who was non compliant with her medications. She developed right flank pain, intermittent fever and vomiting. Imaging revealed a perinephric collection requiring drainage, after which she was scheduled for right ureteroscopic lithotripsy and Double J (DJ) stenting. The present case is notably complex due to her severely reduced EF of 15%, documented regional wall motion abnormalities and moderate valvular regurgitation. Anaesthetic management required careful preoperative planning, including echocardiographic assessment and nephrology consultation. Etomidate was chosen for induction because of its minimal cardiovascular depressant effects, while fentanyl provided analgesia and vecuronium was used for muscle relaxation. The present case underscores the importance of individualised anaesthetic strategies for patients with severe cardiac dysfunction. With appropriate drug selection and multidisciplinary coordination, high-risk cardiac patients can safely undergo non cardiac surgical interventions.