1. LAPAROTOMY FOR A MASSIVE OVARIAN CYST -ANESTHETIC MANAGEMENT A CASE REPORT Dr.R.Selvakumar. M.D.,D.A.,DNB Dr.S.Elango.M.D( Anaes) Dr.B.K.C.Mohanprasad.M.S.,M.Ch Dr.D.Maruthupandian.M.S.( Gen.Sur)

2. OVARIAN TUMOURS ARE KNOWN FOR THEIR MASSIVE SIZES…! S.Z.2004

3. 1.SIZE OF THE TUMOUR 2.ASSOCIATED A.S.D 3.SEVERE ORTHOPNEA 4.BILATERAL HYDRONEPHROSIS 5.? CIRCULATORY COLLAPSE ON SUDDEN DECOMPRESSION S.Z.2004 WHAT MADE ME TO PRESENT THIS CASE HERE…?

4. CASE HISTORY: Name: Indira devi Age : 38 years Weight: 57 k.g History: 4 years duration,painful abdominal distension, severe orthopnea O/E: cachectic, anemic, breathless Vital signs: pulse.112bpm,B.P:90/60, R.R: 28 bpm SpO2: 96% on room air. S.Z.2004

6. INVESTIGATIONS: Hb: 8.2 Gm% Chest X-Ray : ECHO : S.Z.2004

7. ANESTHETIC MANAGEMENT: Preparation: Pre-op packed cell transfusion oral iron prepartion role of pre-op aspiration of ovarian cyst? Premedication: Glycopyrrolate 0.2 m.g I.M S.Z.2004

8. Preinduction: 2 I.V lines- 14G, 18 G one line - gelatin Another line – Dopamine in D.N.S 400 m.g 4μg/kg/min Monitoring: E.C.G, NIBP, Pulseoximetry, Urine output S.Z.2004 ANESTHETIC MANAGEMENT-contd…

9. ANESTHETIC MANAGEMENT: contd…. Pt. was put in 45 0 reclining position Pre-induction : Xylocard 2% 75mgm IV. Induction: Ketamine 75 m.g + midazolam 1m.g Suxamethonium 100 m.g Intubation done with 7.5 cuffed E.T.T Maintenance: Gas+ O2 + fentanyl + atracurium S.Z.2004

10. ANESTHETIC MANAGEMENT: contd… COURSE: Laparotomy- cyst ruptured during dissection Sudden decompression within 10 minutes Dopamine rate increased to 10 μg/kg/min fresh blood started minimal fall of B.P noted Duration: 1 hour 30 min Reversal: Uneventful Recovery: good Post-op analgesia: tramadol 50 m.g I.M S.Z.2004

11. During the dissection…

12. S.Z.2004 The cyst ruptured…

13. At the end of surgery…. S.Z.2004

14. DISCUSSION: Choice of anesthetic technique Induction in an orthopneic patient Tackling circulatory collapse during sudden decompression of abdomen. S.Z.2004

15. Concluding…. “A careful preparation,planning and maintenance of anaesthesia ( plus HIS BLESSING ) will definitely improve the outcome of these type of cases” S.Z.2004