Anesthetic management for upper arm amputation in a patient with acute rapid atrial fibrillation and a large thyroid goiter: A case report.

RATIONALE

Patients with atrial fibrillation and a large goiter have high perioperative risks and often cannot tolerate general anesthesia, making it necessary for us to explore new safe and effective anesthesia methods.

PATIENT CONCERNS

The patient presented with atrial fibrillation accompanied by rapid ventricular rate, a thrombus attached to the left atrial appendage, and a massive thyroid goiter compressing the airway.

DIAGNOSIS

After the left humerus fracture surgery, the patient's internal fixation loosened and fractured, accompanied by infection, formation of sinus tracts, and suppuration. Consequently, an emergency left upper arm amputation was performed.

INTERVENTIONS

An ultrasound-guided subclavian brachial plexus block combined with intercostobrachial nerve block via the axillary region was performed on a high-risk elderly patient.

OUTCOMES

We opted for a multi-regional block technique, which allowed us to avoid the numerous risks associated with general anesthesia. The surgery proceeded smoothly, the patient reported no significant discomfort, and was discharged 1 week postoperatively.

LESSONS

This case demonstrates that a well-executed multi-regional block can provide satisfactory anesthesia, offering a viable alternative for managing anesthesia in high-risk patients.