Anaesthetic Management of Post-CABG Patient for Laparoscopic Incision Hernia Repair at Sternotomy Incision Site
Journal Title: Scholars Journal of Medical Case Reports - Year 2014, Vol 2, Issue 3
Abstract
Pneumoperitoneum by CO2 for laparoscopic surgery results into ventilator and respiratory changes. In compromised patients, cardio-respiratory disturbances aggravate increase in PaCO2 and enlarge the gradient between PACO2 and PETCO2. Changes in PETCO2 are more common in hernia repair because of subcutaneous absorption of CO2, which results into decrease in cardiac output, increase in arterial BP and increase in SVR and PVR. These changes are accentuated in high-risk cardiac patients. We describe the first case of post-CABG patients operated for sub-xiphoid incisional hernia repair under general anaesthesia with thoracic epidural anaesthesia.Patient had grade 3 dyspnoea and intermittent chest pain, which increase cardiac risk of patient for anaesthesia. Patient was taken up for surgery after cardiology reference and by keeping ventilator ready in SICU with ASA grade 4 risk. Electrolyte levels, PT, INR levels after stopping antiplatelet agents were normal preoperatively; patient sedated with Fentanyl and Midazolam. Epidural catheter placed at thoracic level T8-T9 to decrease intraoperative anaesthetic requirement and postoperative pain relief to prevent stress response. Patient was given general anaesthesia with Inj. Propofol and Inj.Vecuronium andmaintained with Sevoflurane to keep MAC level 1.2-1.5 at end tidal concentration. BIS monitor applied to maintain depth of anaesthesia at 40-60 score. Controlled ventilation carried out to maintain ETCO2 at normal range. Postoperatively patient was observed for pain, hypertension. Tachycardia and treated accordingly. Keywords: Post-CABG patient, Sternotomy incisional hernia repair, Laparoscopic surgery
Authors and Affiliations
Dr. Sandhya Gujar, Dr. Shirish Chavan, Dr. Pradnya Jagtap
Keywords
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