1 / 15

LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT. A CASE REPORT. Dr.R.Selvakumar. M.D.,D.A.,DNB Dr.S.Elango.M.D( Anaes) Dr.B.K.C.Mohanprasad.M.S.,M.Ch Dr.D.Maruthupandian.M.S.( Gen.Sur). OVARIAN TUMOURS ARE KNOWN FOR THEIR MASSIVE SIZES…!. S.Z.2004.

atira
Download Presentation

LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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. LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT A CASE REPORT Dr.R.Selvakumar. M.D.,D.A.,DNB Dr.S.Elango.M.D( Anaes) Dr.B.K.C.Mohanprasad.M.S.,M.Ch Dr.D.Maruthupandian.M.S.( Gen.Sur)

  2. OVARIAN TUMOURS ARE KNOWN FOR THEIR MASSIVE SIZES…! S.Z.2004

  3. WHAT MADE ME TO PRESENT THIS CASE HERE…? • SIZE OF THE TUMOUR • ASSOCIATED A.S.D • SEVERE ORTHOPNEA • BILATERAL HYDRONEPHROSIS • ? CIRCULATORY COLLAPSE ON • SUDDEN DECOMPRESSION S.Z.2004

  4. CASE HISTORY: Name : Indira devi Age : 38 years Weight : 57 k.g History : 4 years duration,painful abdominal distension, severe orthopnea O/E : cachectic, anemic, breathless Vital signs : pulse.112bpm,B.P:90/60, R.R: 28 bpm SpO2: 96% on room air. S.Z.2004

  5. S.Z.2004

  6. INVESTIGATIONS: Hb: 8.2 Gm% Chest X-Ray : ECHO : S.Z.2004

  7. 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 S.Z.2004

  8. ANESTHETIC MANAGEMENT-contd… 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

  9. 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

  10. 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 S.Z.2004

  11. During the dissection… S.Z.2004

  12. The cyst ruptured… S.Z.2004

  13. At the end of surgery…. S.Z.2004

  14. DISCUSSION: • Choice of anesthetic technique • Induction in an orthopneic patient • Tackling circulatory collapse during • sudden decompression of abdomen. S.Z.2004

  15. 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

More Related