A 72-year-old female patient with comorbid conditions including congestive heart failure, diabetes, atrial fibrillation, hypertension, and acute abdominal pain was scheduled for a high midline laparotomy surgery. Due to her cardiac risks, the anesthesia team performed a high spinal anesthesia using 2.5 mL of 0.5% bupivacaine plus 2.5 mL of distilled water, which provided a high level of sensory blockade while maintaining hemodynamic stability. The surgery was successfully completed with no pain reported by the patient and no postoperative complications.
Summary:
Epidural Analgesia is effective in the management of perioperative pain --> neural transmission process can be inhibited by epidural analgesia
Epidural Analgesia decreases risk of Venous thromboembolisms, Pulmonary, complications, Arrhythmias, Postoperative ileus, Transfusion requirements, Pain, Stress/immune response
Epidural analgesia can not inhibit the surgical stress response perfectly, because this technique we can not block the circulation pathway / humoral pathway.
Surgical stress response affect the cardiovascular system, respiratory system, gastroinstestinal system, immune system, and metabolic function.
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Summary:
Epidural Analgesia is effective in the management of perioperative pain --> neural transmission process can be inhibited by epidural analgesia
Epidural Analgesia decreases risk of Venous thromboembolisms, Pulmonary, complications, Arrhythmias, Postoperative ileus, Transfusion requirements, Pain, Stress/immune response
Epidural analgesia can not inhibit the surgical stress response perfectly, because this technique we can not block the circulation pathway / humoral pathway.
Surgical stress response affect the cardiovascular system, respiratory system, gastroinstestinal system, immune system, and metabolic function.
Summary notes of Anesthesia. These notes were published in 2020.
You can download them from:
-Mediafire: http://www.mediafire.com/file/wkey81yff7kv3j1/Anesthesia_Q%2526A_2020.pdf/file
Hemodynamic Stress Response of Carbon-Di-Oxide Pneumoperitoneum during Laparo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
2. Special consideration in cardiac rehabilitation program for older adults.ShagufaAmber
An increasing number of cardiac patients are above the age of 65 years . They are susceptible to the adverse effect of bed rest . So early mobilization is especially important to return them to active and independent lifestyle.
- Most of the patients with heart failure, are elderly patients, shooting up to 80% in both incidence and prevalence.This is due to improved and better survival after cardiac insults, such as myocardial infarction, especially in developed countries.(AHA,2013).
-The safety and efficacy of cardiac rehabilitation have been demonstrated in the elderly (age >65 years) .(Pasquali ,et al.,2001)
-CR has a class IA recommendation by the AHA and ACSM for secondary prevention after any coronary heart disease
CPR with ECLS vs conventional CPR in IHCASun Yai-Cheng
Cardiopulmonary Resuscitation with Assisted Extracorporeal Life-Support versus Conventional Cardiopulmonary Resuscitation in Adults with In-Hospital Cardiac Arrest
Lancet 2008; 372:554-561
Patient control epidural analgesia Al Razi hospital KuwaitFarah Jafri
This is the Patient Controlled Epidural Analgesia protocol at Al Razi Hospital. This presentation was done before initiating the PCEA as a pain control modality in the hospital.
The Anesthesiologist, especially young, faces a major challenge when faced with very ill/ severly moribund, elderly, cachwexic patients with history of fall and lower extremity fractures for elective or ortho surgical procedure. Prof. mridul m. panditrao, explains various problems faced especially with GA, and the best alternatives. Two different approaches of Combined spinal epidual are discussed, with use of adjuvants and also his own randomizede trial and experience.
Hemodynamic Stress Response of Carbon-Di-Oxide Pneumoperitoneum during Laparo...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
2. Special consideration in cardiac rehabilitation program for older adults.ShagufaAmber
An increasing number of cardiac patients are above the age of 65 years . They are susceptible to the adverse effect of bed rest . So early mobilization is especially important to return them to active and independent lifestyle.
- Most of the patients with heart failure, are elderly patients, shooting up to 80% in both incidence and prevalence.This is due to improved and better survival after cardiac insults, such as myocardial infarction, especially in developed countries.(AHA,2013).
-The safety and efficacy of cardiac rehabilitation have been demonstrated in the elderly (age >65 years) .(Pasquali ,et al.,2001)
-CR has a class IA recommendation by the AHA and ACSM for secondary prevention after any coronary heart disease
CPR with ECLS vs conventional CPR in IHCASun Yai-Cheng
Cardiopulmonary Resuscitation with Assisted Extracorporeal Life-Support versus Conventional Cardiopulmonary Resuscitation in Adults with In-Hospital Cardiac Arrest
Lancet 2008; 372:554-561
Patient control epidural analgesia Al Razi hospital KuwaitFarah Jafri
This is the Patient Controlled Epidural Analgesia protocol at Al Razi Hospital. This presentation was done before initiating the PCEA as a pain control modality in the hospital.
The Anesthesiologist, especially young, faces a major challenge when faced with very ill/ severly moribund, elderly, cachwexic patients with history of fall and lower extremity fractures for elective or ortho surgical procedure. Prof. mridul m. panditrao, explains various problems faced especially with GA, and the best alternatives. Two different approaches of Combined spinal epidual are discussed, with use of adjuvants and also his own randomizede trial and experience.
This presentation explains change physiological changes occurs in obesity. Which pre op investigation should be done of those patient before scheduling them for surgery. What in the end anaesthesia consideration of obesity with post op care.
Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – O...info622939
Embark on a compelling exploration of anesthesia innovation with our presentation on 'Awake Fiberoptic Intubation with Sedation in Cardiac (High-Risk) Patients – Our Experience.' Delve into the intricacies of this specialized technique, tailored for high-risk cardiac patients, as we share our unique insights and experiences.
Anaesthetic Management of a Patient with HELLP SyndromeMd Rabiul Alam
HELLP syndrome can be an extremely serious and complex multisystem disorder involving much more than just eclampsia. Special considerations in obstetric and anaesthetic management are necessary, to minimize the morbidity and mortality are associated with this syndrome and its complications.
Anaesthetic Management of a Patient with HELLP Syndrome
anesthesia challenge
1. Anesthesia challenge
High Spinal Anesthesia and High Midline Incision for Abdominal surgery.
Can person with high cardiac risk disease go under high spinal anesthesia for high midline
abdominal surgery.
Dr.Iyad Abu Karsh MD. Chief of Anesthesia Department
Dr.Naser Redwan MD. Chief of Surgery Department
Dr.Akram Hussein M.D. Consultant G.A
DR.Hany Saleh M.D G.S
Summary
72 years old female patient with Acute Abdominal Pain, since three days with Co morbid
disease condition such as CHF,DM,AF,HTN, was admitted to OR. For high midline laparatomy
- A High spinal anesthesia was used, where in bupivicain 0.5% 2.5ml +DW2.5ml was used
The benefits of this technique, to avoid cardio respiratory depression under GA. From
anesthetic drugs, high sensation level block, hemodynamic stability, minimal amount of drugs
used, and ability to achieve the desired segmental level of anesthesia.
Key Word :-high spinal anesthesia, CHF, AF ,DM, spinal deformity.
Introduction
The preoperative management for patient with CHF for abdominal surgery is challenge for
anesthesia due to presence of co morbid disease unstable cardio respiratory status
-Anesthesia controversial to GA Regional.
-High spinal anesthesia is challenge method as regional anesthesia for abdominal surgery with
high midline incision.
-We used technique of high spinal anesthesia in some cases with multiple co morbid disease.
Case Report.
A 72 years old female patient, presented to surgery department in K.O. H in February 2015,
complaining of pain in the epigastric region since 3days, vomiting many times, fever,
Patient had DM treated Amaryl 3mg+Glucophage 500mg,HTN treated by amiloride 15mg+AF
digoxin 0.25mg CHF treated by lasix 40mg-convertien 10mg.
Patient was diagnosed as intestinal obstruction. CT waw done Mass under epigastric region
Investigation: -
CBC: Hb: 10.5gm/dl , HCT%: 33 , WBCs: 9,5 PLT: 114 K
Chemistry: FBS:298mg/dl,
2. Creatinine:1 mg/dl, Urea_:-39mg/dl
Other tests :Na 142mg/l -K4.1mmol/l Ca 10 mg/dl
PT 12 sec INR 100% PTT 45sec
Alat 174 IU/dl ALP 100 IU/dl
Preoperative management
Vital signs:
T37C° , Bp:140/75,
RR: 20/min, HR100/min
Clexan 80 mg sc/24
hr-
-NS 500ml IV /24hr
-
- Ranitidine 50 mg
IV/6hr
-ROCIEFEEN 1 g
IV/12hr
-CREBPANDAGE both
legs
Prepare 4 units
PRBCs-
Insulin scale--FLAGYL
500mg/8hR-
Anesthesia Plan :REGIONAL –HIGH
SPINAL
Prepare 4 units
FFP-
-AMIODARONE
150mg
In 100ml G5%
Intraoperative management
- Under full monitoring -ECG-HR-PLO2-BP
- Nasal O2 Canullea 5 L/min.
-& under full septic technique povidine 10%
- local anesthesia 1%-10 ml at level L2-L3
-Spinal Needle (black) G 22- pencil point
- Anesthesia Marcain 5%-2.5ml + DW 2.5ml
- After 5 min test of sensation to level sternum no sensation
- Skin incision -pain score 0
Duration of operation one hour
Postoperative management:
Recovery room for 15 min under monitoring
Then for surgical word patient after 5 days had been discharged safety without any problems
Discussion
Pereoperative management of patient with comorbid disease CHF, AF, DM, HTN, other is
challenge for anesthesia due to high incidence of morbidity and mortality due to
heamodynamic, metabolic heart kidney stress.
High spinal anesthesia is accepted approach for high medline abdominal incision for abdominal
surgery.
3. It include that difficult technique of high spinal anesthesia with high level of sensation or
motor block. The risk oaf hemodynamic or respiratory depression for patient with CHF.
The use of additional DW2.5ml to Bupivicain 0.5%2.5ml make high level of sensation block,
with Autonomic Motor block.
- Additional of 2.5ml DW. make Bupivicain Hypobaric relative to CSF .
Hypobaric Bupivicain makes hemodynamic no changes due to more sensation block and less
Autonomic motor block.
- The regional Anesthesetic agents are used for spinal anesthesia controversial, isobaric
bupivicain was initially preferred, Hypobaric was believed to result in drug stability position in
spinal cord.
To concluded, we reported the successful anesthesia management with high spinal technique
for patient with co morbid disease such as CHF ,AF, vertebral deformity, under go abdominal
laparatomy with high Medline incision.
Spinal anesthesia for high level sensation with bupivicain 0.5%-2.5ml+DW2.5ml was used to
benefits of high level sensation block, less Autonomic motor bloc, and hemodynamic stability.
This technique needs to be in the Anesthesia practice in high risk cardiac patient undergo
abdominal laparatomy with high midline incision.
Dr . IYAD AHMED ABU KARSH
CHIEF OF ANESTHESIA DEPARTEMNT
K.O.H
E-mail: iyasnopain@hotmail.co.il