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Scholars Journal of Medical Case Reports | Volume-2 | Issue-03
Anaesthetic Management of Post-CABG Patient for Laparoscopic Incision Hernia Repair at Sternotomy Incision Site
Dr. Sandhya Gujar, Dr. Shirish Chavan, Dr. Pradnya Jagtap
Published: March 28, 2014 |
121
125
DOI: 10.36347/sjmcr.2014.v02i03.014
Pages: 158-160
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Abstract
Pneumoperitoneum by CO2 for laparoscopic surgery results into ventilator and respiratory changes. In
compromised patients, cardio-respiratory disturbances aggravate increase in PaCO2 and enlarge the gradient between
PACO2 and PETCO2. Changes in PETCO2 are more common in hernia repair because of subcutaneous absorption of
CO2, which results into decrease in cardiac output, increase in arterial BP and increase in SVR and PVR. These changes
are accentuated in high-risk cardiac patients. We describe the first case of post-CABG patients operated for sub-xiphoid
incisional hernia repair under general anaesthesia with thoracic epidural anaesthesia.Patient had grade 3 dyspnoea and
intermittent chest pain, which increase cardiac risk of patient for anaesthesia. Patient was taken up for surgery after
cardiology reference and by keeping ventilator ready in SICU with ASA grade 4 risk. Electrolyte levels, PT, INR levels
after stopping antiplatelet agents were normal preoperatively; patient sedated with Fentanyl and Midazolam. Epidural
catheter placed at thoracic level T8-T9 to decrease intraoperative anaesthetic requirement and postoperative pain relief to
prevent stress response. Patient was given general anaesthesia with Inj. Propofol and Inj.Vecuronium andmaintained with
Sevoflurane to keep MAC level 1.2-1.5 at end tidal concentration. BIS monitor applied to maintain depth of anaesthesia
at 40-60 score. Controlled ventilation carried out to maintain ETCO2 at normal range. Postoperatively patient was
observed for pain, hypertension. Tachycardia and treated accordingly.