Abstracts / Posters

Anaesthetic implications and management of a giant ovarian cyst

Dr.Nalini K B

Institute : M S Ramaiah Medical college, Bangalore.

Introduction
With improvement in health care, improved access to hospitals and better imaging modalities, huge abdominal tumours are rarely seen in modern day surgical practice. They present many challenges to anaesthesiologists. Difficult intubations, life threatening cardiovascular and pulmonary complications, are commonly encountered. Management of such cases is associated with significant mortality and morbidity. The consequences of surgery are mainly attributable to the size of the mass rather than to its distinctive pathology.

Case report
A 50-year-old female presented with an abdominal swelling which gradually increased in size over the past 13 years, due to which she was unable to ambulate. She weighed 90kg, with a circumferential abdominal girth of 170 cms. Preoperative investigations were done. The patient was scheduled for an exploratory laparotomy, with excision of cyst. In view of respiratory distress in the supine position, left lateral position was inevitable for anaesthesia and surgery. An extension was applied to the operating table, to accommodate the tumour. Surgery was performed in the left lateral position and encysted mass was removed in total, which weighed 56.9 kg. Following the removal of the mass, there was hypotension, resuscitated with fluids, blood and ionotropes. The patient was reversed at the end of the procedure and extubated. Her postoperative weight was 32 kg.

Conclusion
Huge ovarian tumours are rarely encountered in the modern day clinical practice. Anesthesiologists must be aware about the anaesthetic challenges that are seen in these cases. A huge ovarian tumour which weighed around 57 kg was successfully removed by providing a meticulous perioperative anaesthetic management.