ISAKanyakumari - Interesting Cases

LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT

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OVARIAN TUMOURS

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…!

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

CASE HISTORY:

Name	Indira devi
Age	38 years
Weight	57 k.g
History	4 years of duration, painful abdominal distension, severe orthopnoea
O/E	cachectic, anemic, breathlessness
Vital signs	pulse-112bpm, B.P - 90/60, R.R - 28 bpm SpO2 - 96% on room air

INVESTIGATIONS

Hb	8.2 Gm%
Chest X-ray

ECHO-CARDIOGRAM

ANESTHETIC MANAGEMENT:

Preparation	Pre-op packed cell transfusion
	Oral iron preparation
	Role of pre-operative aspiration of ovarian cyst?

Premedication	Glycopyrrolate 0.2 m.g I.M
Pre induction	2 I.V lines- 14G, 18 G
	One line - gelatin
	Another line – D.N.S. with Dopamine 400 m.g 4μg/kg/min
Monitoring	E.C.G, NIBP, Pulse-oximetry, Urine output

	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

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

During the Dissection

The cyst ruptured…

At the end of surgery….

PROBLEMS:

• Choice of anesthetic technique

• Induction in an orthopnoeic patient

• Tackling circulatory collapse during

• sudden decompression of abdomen.

Concluding...

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

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