Anesthetic implications for transurethral resection of prostate in a COVID-19 survivor with Stanford-A aortic dissection with acute urinary retention due to metastatic carcinoma prostate: a case report

BACKGROUND: Aortic dissection is a new addition to the long COVID-19 complication catalog. We report this rare and novel complication, which can be missed without a high index of suspicion in the ever-burgeoning population of COVID-survivors presenting for un-related surgery. We emphasize the importance of recording blood pressure in both the upper limbs in COVID-survivors during pre-anesthetic checkup, especially in patients with a dilated aorta on the chest radiograph to identify any interarm blood pressure discrepancy characteristic of aortic dissection. Discontinuation of antihypertensive based on low/normal blood pressure in left upper limb can precipitate concealed and catastrophic rise in blood pressure in the right upper-limb propagating the dissection of aorta to a fatal conclusion. The cardinal anesthetic consideration is to mitigate the effect of hemodynamic perturbations on the dissected aorta. CASE PRESENTATION: We report the successful management of the case of a 76-year-old male prostatic cancer patient with COVID-induced aortic-dissection and acute urinary retention, posted for transurethral resection of prostate. CT angiography revealed an intimal flap in the ascending aortic lumen and aortic arch till the origin of left subclavian artery resulting in a double-barreled aorta. An arterial line was secured in right radial artery and non-invasive blood pressure recorded in left arm simultaneously (202/60 mmHg in right upper-limb and 92/70 mmHg in the left upper-limb on wheeling into the operation theatre). He underwent transurethral prostatic resection and bilateral orchidectomy under low-dose subarachnoid block with prophylactic use of labetalol infusion. CONCLUSIONS: The importance of recording blood pressure in both the upper limbs in COVID survivors maintaining a high index of suspicion for aortic dissection cannot be overemphasized. Transurethral prostatic resection surgery under low-dose subarachnoid block is possible under the umbrella of judicious selection and optimal use of cardiac medication with an interventional cardiologist as standby in patients with aortic dissection.