Cardiac patient for lung surgery: Walking the tightrope

A patient with poor cardiac function undergoing any surgery under any form of anaesthesia is at high risk for perioperative morbidity and mortality. Both open thoracic surgery and emergency laparotomy in these patients are associated with high incidence of postoperative pulmonary and cardiac complications. Perioperative assessment and multidisciplinary approach are key to managing such cases. Having a clear plan for induction, invasive monitoring, intraoperative fluid management and post-operative analgesia is important for a positive outcome. We present a case of an elective open pulmonary lobectomy and emergency laparotomy conducted within an interval of 7 days in a patient with adenocarcinoma lung and ischemic heart disease with ejection fraction of 10-15%, highlighting the perioperative challenges and management.