iarjmcrIARJMCRIARJMCR2709-3220https://doi.org/10.47310/iarjmcr.2022.v03i02.015Perioperative Management of a Patient of Dual Valve Replacement with Atrial Fibrillation on Anticoagulants and Digoxin Posted for CranioplastySupriyaAgrawalJidnyasaMoonJullyTipleSudhaJainSuchetaTidkeMahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, IndiaPatient with prosthetic heart valves prove to be a challenge for an anaesthesiologist for management as these patients have risk of developing Infective Endocarditis, bleeding and thrombosis and MACE. Patients especially with mechanical valves are prone for thrombosis and complications if anticoagulation is not maintained properly. When these patients are planned for any major surgery, it is best to normalize the coagulation profile right before the procedure and continue anticoagulation as soon as possible. Management of patients with prosthetic heart valves undergoing non-cardiac surgery entails cardiac evaluation for valvular function, residual pathology, infective endocarditis and functional status; assessment of the anticoagulation status, any risk of bleeding, preparation for reversing anticoagulants intraoperatively if necessary and neurological evaluation for identifying any neurological impairment caused by thromboembolism. We present the effective anaesthetic management of a patient who was a known case of Rheumatic Heart disease and had prosthetic mitral and aortic valves with history of craniotomy and was posted electively for cranioplasty.