Hemodynamic instability is the main concern in constrictive pericarditis posted for emergency procedure.

Anaesthetic management of a case of chronic Tuberculous constrictive pericarditis Presenting with acute symptoms for Emergency pericardiectomy Rationale Hemodynamic instability is the main concern in constrictive pericarditis posted for emergency procedure.

A 12 year old girl (30kg) with history of breathlessness ,abdominal distention, pedal edema and oliguria. She was also having low grade fever,loss of weight ,appettite. Based on the History, clinical examination, X ray chest, Echo with bilateral effussion and patient posted for emergency pericardiectomy. In OT patient proceeded with general anaesthesia after securing IV access, CVP,ABP and connected to monitors.patient preoxygenation with 100% O2 induced with inj. Atropine 0.6mg+inj.midazolam 0.5mg+ 60mics of Fentanyl + 60mg of Ketamine + 3mg of vecuronium Intubated with 6.5 mm cuffed ET, BAE checked connected to IPPV mode of ventilation. Maintained with O2:N2O 50:50 with ISOFLURANE 0.4%. ICD on Right side 1200 ml Of pleural fluid drained. Intraoperatively Patient infused with crystalloids, blood and Inj.Dobutamine 5mics/kg started. Intraop vitals maintained and uneventful. Intercostal block was given with inj Bupivacaine 0.25% ,Patient reversed with inj.Neo 1.5mg + inj.Atropine 0.6mg. Recovery fair then shifted to PACU for observation.

Etiology of pericardial disease is important. If neoplastic, metabolic, uraemic and autoimmune disease causing constrictive pericarditis the definitive procedure should be postponed until the causative disorder is stabilised. Generous fluid, vasopressor infusions and vagolytics may be useful.

Tuberculous constrictive pericarditis is rare but important disease in India. Preoperative preparation ,Peroeperative, postoperative management is challenging .