RESUMEN
It is not an uncommon situation to encounter a patient with anesthesia having multiple co-morbidities. Here, we report the successful anesthetic management of an immunosuppressed 53-year-old female patient with hypertrophic obstructive cardiomyopathy, stage IV chronic kidney disease, and chronic lung infection who was posted for minimally invasive video-assisted thoracoscopy requiring one lung ventilation. Intraoperative hemodynamic stability was maintained with etomidate, fentanyl, cisatracurium, desflurane, and dexmedetomidine with accurate bispectral depth for sedation and precise fluid guidance with transesophageal echocardiography. The entire anesthetic conduct was planned to avoid the left ventricular outflow tract obstruction and maintain a steady-state hemodynamic balance. This case report is a learning experience of how close vigilance with appropriate use of monitoring and knowledge about disease per se resulted in an uneventful perioperative period.