laparotomy for a massive ovarian cyst -anesthetic management a case report dr.r.selvakumar....
TRANSCRIPT
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LAPAROTOMY FOR A MASSIVE OVARIAN CYSTLAPAROTOMY FOR A MASSIVE OVARIAN CYST-ANESTHETIC MANAGEMENT-ANESTHETIC MANAGEMENT
A CASE REPORT
Dr.R.Selvakumar. M.D.,D.A.,DNBDr.S.Elango.M.D( Anaes)Dr.B.K.C.Mohanprasad.M.S.,M.ChDr.D.Maruthupandian.M.S.( Gen.Sur)
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OVARIAN TUMOURS ARE KNOWN FOR THEIRMASSIVE SIZES…!
S.Z.2004
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1. SIZE OF THE TUMOUR2. ASSOCIATED A.S.D3. SEVERE ORTHOPNEA4. BILATERAL HYDRONEPHROSIS5. ? CIRCULATORY COLLAPSE ON
SUDDEN DECOMPRESSION
S.Z.2004
WHAT MADE ME TO PRESENT THIS CASE HERE…?
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CASE HISTORY:
Name : Indira deviAge : 38 yearsWeight : 57 k.gHistory : 4 years duration,painful abdominal
distension, severe orthopneaO/E : cachectic, anemic, breathlessVital signs : pulse.112bpm,B.P:90/60, R.R: 28 bpm
SpO2: 96% on room air.
S.Z.2004
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S.Z.2004
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INVESTIGATIONS:
Hb : 8.2 Gm%
Chest X-Ray :
ECHO :
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ANESTHETIC MANAGEMENT:
Preparation : Pre-op packed cell transfusion oral iron prepartion role of pre-op aspiration of
ovarian cyst?
Premedication : Glycopyrrolate 0.2 m.g I.M
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Preinduction : 2 I.V lines- 14G, 18 G one line - gelatin Another line – Dopamine in D.N.S 400 m.g
4μg/kg/min
Monitoring : E.C.G, NIBP, Pulseoximetry, Urine output
S.Z.2004
ANESTHETIC MANAGEMENT-contd…
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ANESTHETIC MANAGEMENT: contd….
•Pt. was put in 450 reclining position•Pre-induction : Xylocard 2% 75mgm IV.•Induction : Ketamine 75 m.g + midazolam 1m.g
Suxamethonium 100 m.g•Intubation done with 7.5 cuffed E.T.T
•Maintenance : Gas+ O2 + fentanyl + atracurium
S.Z.2004
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ANESTHETIC MANAGEMENT: contd…
COURSE : Laparotomy- cyst ruptured during dissection
Sudden decompression within 10 minutes
Dopamine rate increased to 10 μg/kg/min
fresh blood started
minimal fall of B.P noted
Duration : 1 hour 30 min
Reversal : Uneventful
Recovery : good
Post-op analgesia: tramadol 50 m.g I.M
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During the dissection…
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The cyst ruptured…
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At the end of surgery….
S.Z.2004
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DISCUSSION:
•Choice of anesthetic technique•Induction in an orthopneic patient•Tackling circulatory collapse during
sudden decompression of abdomen.
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Concluding….
“A careful preparation,planning and maintenance
of anaesthesia ( plus HIS BLESSING ) will definitely
improve the outcome of these type of cases”
S.Z.2004