laparotomy for a massive ovarian cyst -anesthetic management

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LAPAROTOMY FOR A MASSIVE OVARIAN CYST LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT -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)

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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. - PowerPoint PPT Presentation

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Page 1: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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)

Page 2: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

OVARIAN TUMOURS ARE KNOWN FOR THEIRMASSIVE SIZES…!

S.Z.2004

Page 3: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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…?

Page 4: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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

Page 5: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

S.Z.2004

Page 6: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

INVESTIGATIONS:

Hb : 8.2 Gm%

Chest X-Ray :

ECHO :

S.Z.2004

Page 7: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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

Page 8: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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…

Page 9: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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

Page 10: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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 minReversal : UneventfulRecovery : goodPost-op analgesia: tramadol 50 m.g I.M

S.Z.2004

Page 11: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

S.Z.2004

During the dissection…

Page 12: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

S.Z.2004

The cyst ruptured…

Page 13: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

At the end of surgery….

S.Z.2004

Page 14: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

DISCUSSION:

•Choice of anesthetic technique•Induction in an orthopneic patient•Tackling circulatory collapse during sudden decompression of abdomen.

S.Z.2004

Page 15: LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

Concluding….

“A careful preparation,planning and maintenance of anaesthesia ( plus HIS BLESSING ) will definitelyimprove the outcome of these type of cases”

S.Z.2004