Interesting Case of Ruptured Ectopic Pregnancy Presenting with WPW syndrome. Dr Dinesh Kumar Post graduate Dr P.S.Nag Head of the Department Dr Poorna Chandran Senior Resident Meenakshi Medical College & Research Institute

History A 24 year old women who was a known case of WPW syndrome presented to the casualty with  Severe Lower Abdominal pain,  Vomiting,  Giddiness.

EXAMINATION She was pale, Severely dehydrated, Pulse was 170, BP was 80/60, Abdomen was tender and rigidity +, CVS,RS were normal.

Opinion Emergency Ultra sound was done & Obsterician diagnosed Ruptured ectopic Pregnancy. She was posted for Emergency Lapratomy.

ANAESTHETIC MANAGEMENT Peripheral IV Line was secured with 14 G and 16 G needle, Patient was resuscitated with blood transfusion. Basic Investigations were done, HB was 5.3, ECG showed tachy cardia. No arrythmias.

Intra op Patient was connected to Basic monitoring, Premedication Given with Glycopyrolate & Fentanyl Pre Oxygenated with 100 % oxygen for 5 mins Induction done with Propofol & Succinyl Choline Intubated with 7.5 ET Tube bil air entry checked Maintanence with 50 : 50 N2o & O2, Isoflurane 0.6% Atracurium Nil signiicant events intra operatively All measures were kept ready to manage tachy or brady arrythmia

Post Op Patient was shifted to Surgical ICU post operatively and extubated after full recovery and hemodynamic ally stable. Post operatively she developed Hypoxia she was re-intubated and managed with IPPV for one day and extubated next day. she recovered well and she was discharged on 10 th day.

Complete Diagnosis Post operatively we got the old records which showed WPW syndrome post ablation status- EPS showed sucessful abalation Though she was sucessful case of post RF abalation we treated here as a case of WPW syndrome and took all precaution to prevent complication of WPW syndrome …..

WPW Syndrome

What exactly is WPW syndrome? Syndrome with Accessory pathway between atria & ventricle This results in preexcitationof ventricle Associated with tachycardia

QRS starts earlyCurve is slurred –going through muscleThis

Discussion WPW syndrome --- Post RF abalation status presenting with severe shock for Lapratomy how to manage ?

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