1 / 29

CASE REPORT – RIGHT HEPATECTOMY Dr.M.MuthuShenbagam,MD( Anes ),DA. Asst.Professor Dept.of Anaesthesia , Kanyakumari Govt

CASE REPORT – RIGHT HEPATECTOMY Dr.M.MuthuShenbagam,MD( Anes ),DA. Asst.Professor Dept.of Anaesthesia , Kanyakumari Govt.Medical College Hospital.

alpha
Download Presentation

CASE REPORT – RIGHT HEPATECTOMY Dr.M.MuthuShenbagam,MD( Anes ),DA. Asst.Professor Dept.of Anaesthesia , Kanyakumari Govt

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE REPORT – RIGHT HEPATECTOMYDr.M.MuthuShenbagam,MD(Anes),DA.Asst.ProfessorDept.ofAnaesthesia,KanyakumariGovt.Medical College Hospital.

  2. 51yrs old Mr. Stephen from Nagercoil,admitted at KGMCH with C/o. Abdominal pain > 6 months.Diagnosed by CT as Giant Hemangioma (Rt) lobe of liver.

  3. INVESTIGATIONS Hb - 10 gms % LFT- WNL Coagulation profile - WNL

  4. Planned for Rt Hepatectomy. • Assessed • Procedure & risk explained to the patients and relatives. • Adequate blood reserved.

  5. Patient was shifted to OT.Started IV lines 2 widebore 16G venflon – Rt&Lt arm. One 18G venflon in LL.

  6. Monitors. - Pulse oximeter - NIBP - ECG - CVP -Urine output

  7. ANAESTHESIA PLAN ETGA + Thoracic Epidural Anesthesia

  8. Emergency drugs ,NTG, Dopamine infusion kept ready.Premed : -Inj.Glycopyrolate 0.2mg IV - Midazolam 2mg IV - Pethidine 50mg IV

  9. Under Asepsis Rt Internal jugular vein cannulated &Triple lumen CVP catheter inserted under seldinger technique & distal port used for CVP measurement.

  10. Under asepsis, RT lat-position, 18G Epidural Catheter inserted in T10-T11space& 5cm kept inside& 10ml of 0.2% Ropivacaine + 25mcg Fentanyl given through Epidural Catheter

  11. INDUCTION : Thiopentone 250mg IVScoline 75mg IVINTUBATION : 8.0 ID Endo tracheal tube & BAE checked

  12. MAINTENANCE – N2O/O2- Fentanyl - AtracuriumLA supplementation thro Epidural.

  13. Fluid- Maintenance with Crystalloids& Colloids.CVP was kept in the range of 4-6 cm water.NTG infusion was used to minimize blood loss.

  14. Vascular control was done with inflow clamping of Hepatic A / portal vein (Pringle maneuver)

  15. Intra operatively, during resection phase, huge blood loss from middle hepatic veins.BP to 60/40mmHg

  16. MANAGEMENT: - Mephentermine 12 mg Bolus - Colloids/Blood 2 units rushed - Dopamine drip - which was stopped after control BP to 100/70mmHg

  17. Rest of the intraop period- uneventfulSurgery lasted for 6 hrs.Blood loss – app. 2 to 3 lit.Intraoperativly 6 units of blood transfused & calcium supplement given.

  18. At the end of procedure – reversal with Neostigmine + GlycopyrolateExtubated awake.Postop period – Vitals – StableShifted to ISCU.

  19. Problems in Liver Resection Long operation time Fluid Shifts Sudden unexpected blood loss Coagulopathy Hypothermia

  20. Low CVP Technique – controversial • Aids surgery • Minimise blood loss • But, increased risk of Airembolism • Potential for Hemodynamic instability if bleeding is sudden & significant

  21. THANK YOU

More Related