Myxomas are the most common primary benign intracavitatory tumour with the incidence of 0.5 per million populations. Myxomas account for 0.3% of all cardiac surgeries performed. Clinically, they are characterized by a triad of embolisation, obstruction of blood flow, and constitutional symptoms (Goodwin’s triad). Meanwhile Parkinson's disease is a degenerative neurologic disorder caused by degeneration of nerve cells in the substantia nigra causing weakness motor coordination. Symptoms include tremor, bradykinesia, rigidity, and postural instability. Achieving a satisfactory hemodynamic performance is the primary objective in the management of cardiac surgery patient. Optimal cardiac function ensures adequate perfusion and oxygenation of other organ systems (in particular vital organs) and improves the chances for an uneventful recovery from surgery. A 61-year old female diagnosed with Coronary Artery Disease 3 Vessel Disease (CAD 3 VD), Parkinson’s disease, and left atrial myxoma was brought to the emergency department with dyspnea. The patient has undergone angiography and the echocardiography result was LVEF 59% with global normokinetic, LA myxoma causing non-significant mitral flow. LA myxoma excision under general anaesthesia on CPB was planned. Balanced general anaesthesia on cardiopulmonary bypass forms the basis of Anaesthetic management of Cardiac myxomas. However specific individual considerations will have to be made regarding drugs, doses, regional anaesthetic choices, anticoagulation and post-operative management. There is no simple anesthetic technique for patients with Parkinson’. Therefore, careful preoperative assessment, administration of drugs during and after anesthesia, as well as avoiding agents that are known to trigger Parkinson's symptoms is a major factor in reducing postoperative morbidity and mortality.
Hemorrhagic shock is a form of hypovolemic shock in which severe blood loss leads to inadequate oxygen delivery at the cellular level. Death from hemorrhage represents a substantial global problem, with more than 60,000 deaths per year in the United States and an estimated 1.9 million deaths per year worldwide, 1.5 million of which result from physical trauma. This case report aims to stress the need of handling cases of hemorrhagic shock in accordance with damage control protocol.
Hemorrhagic shock management using permissive hypotension management, bleeding control, massive transfusion protocol (MTP), minimal crystalloid therapy, and adjuvant therapy is the best approach to get optimal outcome to prevent triad of death. In this case, the application of damage control resuscitation has not been fully implemented because of several constraints.
Key words: Hemorrhage; Hemorrhagic shock; Permissive hypotension; Massive Transfusion Protocol; MTP; Resuscitation; Damage control
Citation: Pohan DK, Sudjud RW, Kurniawan MB, Ramila HN. Anesthetic management on patient with hollow viscus perforation due to blunt abdominal trauma with grade IV hemorrhagic shock. Anaesth. pain intensive care 2021;25(2):217-221. DOI: 10.35975/apic.v25i2.1474
Received: 11 January 2021, Reviewed: 15 January 2021, Accepted: 16 February 2021
Introduction: Achieving a satisfactory hemodynamic performance is the primary objective in the management of cardiac surgery patient. Optimal cardiac function ensures adequate perfusion and oxygenation of other organ systems (in particular vital organs) and improves the chances for an uneventful recovery from surgery. Case: A 46 year old male diagnosed with Coronary Artery Disease 3 Vessel Disease (CAD 3 VD), CTO in LAD and RCA, history of hypertension, extensive myocard infarction with hypertrophy as well as global function impairment of the left ventricle and low ejection fraction, who underwent Coronary Artery Bypass Graft (CABG). Supportive medications, such as dobutamine and nitroglycerin (NTG) were initiated and maintained intraoperatively, especially after anesthetic induction due to hemodynamic alterations. Patient was able to wean from cardiopulmonary bypass (CPB) machine and transferred to the ICU postoperatively.
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