This document summarizes a patient's medical history and details of a surgical procedure under anesthesia. A 45-year old male patient presented with vomiting, weight loss, abdominal pain and fatigue. He had a history of perforation and laparotomy surgery. The patient was diagnosed with CKD and diabetes. He underwent a total spinal anesthesia for a 2-hour surgery to investigate enlarged mesenteric lymph nodes. During the procedure, the patient experienced hypotension and bradycardia due to the spinal anesthesia. He was intubated and given intravenous fluids and medications to stabilize him. After the surgery, the patient was extubated and able to follow commands with normal vital signs.

1. Morbidity
TOTAL SPINAL
Team involved:
DR.Charles Associate Prof.
DR.Harith(PG)
TITLE WITH THE TEAM INVOLVED
Patient Viveganantham
Age -45/M
Weight -40 Kg
Height – 160Cm

2. Brief History :
Diagnosis:
Surgical Procedure:
Comorbidities
&
Drug history
h/o prev admission to hospital 6 months back
Diagnosis-Perforation
Procedure-Laprotomy
ICU admission, CKD not on HAemodyalysis
K/c/o DM on iregular medication
At present Inj.Insulin ACTRAPID AND INJ.MONOTARD
Presented with complains of
h/o vomiting x 3 months on and off
containg food particles
h/o weight loss
h/o loss of appetite,h/o intake of less quantity of food
h/o abdominal pain in epigastric region
h/o fatigue
no h/o URI and LRI
Alcoholic for 5 years stopped 7 months back
No h/o difficulty in passing Urine or passing Stools

3. Conscious
Oriented
Pallor +
NO ICTERUS ,CYANOSIS
CLUBBING
LYMADNEPATHY
Poorly Hydrated
CFT <TWO SEC
Effort Tolerance 4 METS
Good Venous Acesss
PR : 102 vol: good
RR : 16
NIBP : 110/60
Temperature : afebrile
RS :B/L AE +, NVBS
Breathholding-30sec
CVS: S1S2 heard , no
murmurs.
PA –Soft BS+
Snoring history : no
Mouth
opening:adequate
MPC : class 2
Nasal patency : patent
Mentohyoid :3 fb
Teeth : NLT
GPE
AIRWAY EXAMINATION
VITALS Systemic examination

4. Hb : 9.4 gms%
TC :8500 cells/cu.mm
DC : N -63.9 /L-29.3 M-
4.3 /E-2.3
Platelet count: 3.28 L
Blood urea : 54mg/dl
S creatinine:3.77 mg/dl
Routine investigations
Na-!30
K 3.8
Cl-102
Albumin 2
T.Bilirubin 1.2
AST
ALT
ALP

5. ANAESTHETIC PLAN
Peri-op Risk Factors
Hypovolemic
Diabetes
CKD
Thin Built-Malnourished
S/P Laprotomy
Duration: 2hrs
Blood loss: > 500 ml.
Position:supine
Incision
Hypotension
Bradycardia
Arrhythmias
Cardiac Arrest
Patient factors Surgical factors Anaesthesia factors
IVF NS @50 ml/hr overnight
Reeserve Adequate Blood
Inform Consent
IV line 16G cannula
GA with Epidural

6. Postioned for Epidudural in Sitting Position
Machine Checked,Emergency Drugs , Loaded
On table at 9.00 am
Connected to monitor
HR-106 IBP 106/70 Spo2 99%
R arm 16G venflon secure IVF NS
T10-T11 Dural Tap
After negative aspiration of blood and CSF test
dose given with 2%lignocaine with adrenalin
T9-T10 space got at 4 cm catheter fixed at 9 cm to skin
I
N
T
R
A
O
P

7. BP 80/50 74/50 pulse volume was low
After Test dose
Patient felt giddiness
Numbnes in both Upper limbs unable to
squeeze the finger
Unable to Phonate
BREATHLESS,
But He was Consious and Responding to
Commands
Incision at 10.00 AM
One unit fluid given Started on Inj.Dopamine
I
N
T
R
A
O
P
Patient Intubated with Thio 125 mg Vec 4mg Fentanyl 80 mcg
Intubated with 8 size tube fixed at 20 cm

8. Findings – Mesentric Lymph nodes were enlarged
suggestive of metastasis
I
N
T
R
A
O
P
Inj.Dopamine tappered and stopped CBG 126
Patient Extubated
After Extubation
Able to Obey commands
Upper limb power 5/5
Able to phonate
Adequate Tidal volume
BP 140/80 HR 106
2units of NS , 150ml urine ,blood loss 100ml
INPUT OUTPUT