Challenges of managing a post-arrest resuscitated patient for urgent CABG and concomitant non-cardiac surgery under same anaesthesia
Journal Title: Medpulse International Journal of Anesthesiology - Year 2019, Vol 9, Issue 3
Abstract
Background: Coronary artery disease is a leading cause of morbidity and mortality.2016 Heart disease and Stroke Statistics of AHA reported 15.5 million people more than 20 years in USA have CAD, number increasing with age. Men in New Delhi have 4 times higher (2.5vs 9.7%) prevalence of CAD than Framingham.1.CAD is higher in Asians including Asian Indian women. CAD is characterised by atherosclerosis in coronary arteries which can be asymtomatic. Any activity which increases oxygen demand of heart in atherosclerosed arteries with limited ability to fulfil the demand will result in angina, MI or ACS. Treatment modalities include medical management or PCI or CABG.CABG is a major surgery rarely combined with non-cardiac surgery under same anaesthesia. Rare cases of gastric and oesophageal cancer surgeries have been combined with CABG. We report a case of CABG combined with ORIF right supracondylar fracture done successfully under same anaesthesia. Case Report: We report a case of a 60 years old Asian male who developed angina while driving a motorbike leading to fall causing fracture right supracondylar closed communited with intra-articular extension with closed fracture 3rd metacarpal right hand. The patient was taken to nearby trauma centre, where he arrested, was revived according to ACLS guidelines and shifted to our centre. The patient was successfully managed for MI, CHB, ARF, DM and Type 1 respiratory failure. The patient underwent CABG and ORIF right supracondylar fracture under same anaesthesia setting. The anaesthetic management of a patient for concommitant cardiac and long bone fracture surgery is a challenge to the anaesthesiologist and requires intensive preoperative stabilization and meticulous intraoperative and postoperative management. There are very few such cases reported. The possibilities of combining cardiac and noncardiac surgeries under same anaesthesia need to be further investigated.
Authors and Affiliations
Rupinder Kaur Kaiche, Rahul kaiche, Yogesh Chaudhari
Keywords
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- EP ID EP521276
- DOI 10.26611/10159314
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