ISA KANYAKUMARI

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…!

 

OVARIAN TUMOURS

 

WHAT MADE ME TO PRESENT THIS CASE HERE…?

SIZE OF THE TUMOUR
Cases ASSOCIATED A.S.D
Cases SEVERE ORTHOPNEA
Cases BILATERAL HYDRONEPHROSIS
Cases CIRCULATORY COLLAPSE ON SUDDEN DECOMPRESSION

 

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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
Ovarian Tumours
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INVESTIGATIONS

 

Hb 8.2 Gm%
Chest X-ray
   
ECHO-CARDIOGRAM
   
   

 

 
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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
 
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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
Dissection
The cyst ruptured…
At the end of surgery….
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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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