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medical discussion

54 Year Male Patient, Post Cholecystectomy

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2015-06-24 20:18:57

I had 54 yrs old male ASA I, post cholecystectomy with H/O fever, R abdominal pain since 4 days,admitted for ERCP under GA, pt induced with fantasy100mcg, proposal 60mg, attach rim 40 mg, Intubation and anesthesia maintained with O2, NO, ISO,after 10 min during procedure pt had desaturated, hand ventilated with 100%O2, ET tube position confirmed, pt picked up saturation so procedure restarted, again pt dropped his EtCO2 , saturation n went in PEA,IMMEDIATELY cardiac resuscitation started but even after immediate measures could not able to revive the pt.

If anybody having any experience in such cases, please share and any suggestions are welcomed.

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Dr.  Ursula
2015-06-25 05:43:05

a person undergoing a procedure under GA with good ventilation...suddenly desaturates..means...there must be a sudden development of pulmonary edema or a Massive pulm. embolism....was there a drop in his BP?...his saturation normalised with 100% O2, temporarily...i think its a lesson to be learnt that when something goes wrong unexplained...it better to stop the procedure, than to proceed....

Dr.  George
2015-06-25 05:38:23

Drop in Etco2 and Spo2,and PEA,I will put my money on Massive Pulmonary Embolism,unless it is proved otherwise.,These type of cases are usually missed in pre op evaluation too,As this was a postoperative case,and pt was bed ridden,it goes more in favour of it.In pre op evaluation,one need to be careful giving Anesthetics to post op cases and pts with H/o DVT,Obesity,Lethargic & immobile pts,H/o medications like contraceptives etc where a pre op LMWH or Heparin 5000iU can be given s.c with use of compression devices on both legs or compression stockings..

Dr.  Crispin
2015-06-24 22:29:18

One must rule out cardiomyopathy,especially dialated type, which may be lurking & manifesting when pt is subjected to stress situations like stormy post op& immediate second exposure to anaesthesia & surgery. It is always prudent to get Echo card done. before taking up the pt.Cardiomyopathy is almost impossible to treat if pt is not treated pre op.

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