Perioperative Anesthetic Management of a Patient with Oral Tongue Carcinoma and Triple Vessel Coronary Artery Disease: A Case Report

Abstract

Background: Patients with oral cancer often present with distorted airway anatomy and associated comorbidities that complicate anesthetic management. Coronary artery disease, particularly triple-vessel involvement with impaired ejection fraction, further increases perioperative morbidity and mortality.

Methods: We present the case of a 67-year-old male with carcinoma of the tongue, uncontrolled diabetes mellitus (HbA1c 11.2%), and newly diagnosed triple-vessel disease (LVEF 45%, RWMA, mild MR). The anesthetic strategy included invasive monitoring, optimization with beta-blockade, and preparation for difficult airway management.

Results: Initial direct laryngoscopy failed. Videolaryngoscope-assisted nasal intubation with Frova introducer successfully secured the airway without desaturation. Intraoperative hypotension and ventricular premature complexes were managed with goal-directed fluids and low-dose noradrenaline infusion. Postoperative extubation was safely performed over an airway exchange catheter. The patient had an uneventful recovery and was discharged on postoperative day 2.

Conclusion: This case highlights the importance of meticulous preoperative optimization, readiness for advanced airway strategies, and hemodynamic vigilance in managing patients with combined airway distortion and severe cardiovascular comorbidity.