Anesthesia Management for Intra-Aortic Balloon Pump Insertion: A Case Report

Alberth Teddy Kasmarandi; Mayang Indah Lestari; Fredi Heru Irwanto

doi:10.64531/g5pv4d84

Authors

Alberth Teddy Kasmarandi Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya / Dr. Mohammad Hoesin Hospital, Palembang, Indonesia Author
Dr. dr. Mayang Indah Lestari, Sp.An-TI., Subsp. TI(K) Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya / Dr. Mohammad Hoesin Hospital, Palembang, Indonesia Author
dr. Fredi Heru Irwanto, Sp. An-TI., Subsp. AKV(K) Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya / Dr. Mohammad Hoesin Hospital, Palembang, Indonesia Author

DOI:

https://doi.org/10.64531/g5pv4d84

Keywords:

Intra-Aortic Balloon Pump, IABP, Cardiogenic Shock, Anesthesia Management, CABG, Counterpulsation

Abstract

Introduction: Intra-aortic balloon pump (IABP) is the most widely used mechanical circulatory support device in patients with hemodynamic instability, including cardiogenic shock and acute myocardial ischemia. Anesthesia management for IABP insertion demands a highly integrated approach, balancing rapid procedural requirements with myocardial protection and hemodynamic stability. This report presents a case of anesthesia management in a critically ill patient undergoing IABP insertion concurrent with coronary artery bypass grafting (CABG).

Case: A 64-year-old male with cardiogenic shock, three-vessel coronary artery disease, and reduced ejection fraction (32%) underwent CABG with concurrent IABP insertion under general anesthesia. Induction utilized propofol, midazolam, fentanyl, and rocuronium. Intraoperative management included invasive hemodynamic monitoring, goal-directed fluid therapy, and ventricular arrhythmia prevention. The patient required inotropic support with dobutamine, milrinone, and epinephrine postoperatively, with IABP providing hemodynamic augmentation.

Discussion: Key anesthesia considerations include airway management with hemodynamic-sparing induction agents, invasive monitoring, real-time transesophageal echocardiography guidance, IABP timing and management, and prevention of perioperative ventricular arrhythmias. Oxford Handbook principles regarding IABP physiology, insertion technique, timing optimization, and complication management are integrated with the clinical findings.

Conclusion: Successful anesthesia management for IABP insertion requires meticulous hemodynamic optimization, appropriate induction agent selection, real-time imaging guidance, and vigilant perioperative monitoring. The integration of established IABP management principles with individualized anesthetic care is essential for favorable patient outcomes.

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