Anaesthetic management of a patient with cardiac sarcoidosis for non-cardiac surgery

Abstract

Cardiac sarcoidosis is a rare but potentially life-threatening manifestation of systemic sarcoidosis, often presenting with arrhythmias, conduction abnormalities, and impaired myocardial function. Perioperative management of patients with cardiac sarcoidosis for non-cardiac surgery poses significant challenges due to the risk of sudden cardiac events, haemodynamic instability, and altered responses to anaesthetic agents. We present the case of a patient with diagnosed cardiac sarcoidosis who underwent laparoscopic bilateral inguinal hernia mesh repair under general anesthesia. Comprehensive preoperative evaluation included cardiac imaging and electrophysiological assessment, with multidisciplinary input from cardiology, neurology, gastroenterology and anesthesiology teams. Intraoperative management focused on maintaining hemodynamic stability, continuous cardiac monitoring, and readiness for immediate intervention in the event of arrhythmogenic complications. The anesthetic plan was tailored to minimize myocardial depression and autonomic fluctuations. Postoperative care emphasized close monitoring and early detection of arrhythmic or heart failure symptoms. This case highlights the importance of meticulous perioperative planning and individualized anesthetic strategies to safely manage patients with cardiac sarcoidosis undergoing a non-cardiac surgery.