Recently I was to evaluate a case planned for Vaginal Hysterectomy with procedentia prolapse repair. She is 70 yr old and moving around in side house..very much disturbed with complete prolapse and badly wants this operation. She is from a rular area and local OG specialists and Anaesth ,donnot want to take up the case..for...
She had a checkup with a cardiologist and the Echo findings were broadly A case of CAD, AS, AR,(mild) ,LVH as well as an LV annerism in LAD area. EF 42%. Some RWMA, mild Systolic dysfunction as well as diastolic dysfunction. While I was discussing the risk for Anaesthesia and surgery. She said she does not want to die, though she is not afraid of death. She admitted the cardiologist advised to do the operation where there is good ICU there is good Anaesthesia doctor and a cadiologist standby ( all mis pronounced).
The only reason I thought to take up the case. She moves around the house , does
cooking etc . Breathlessness is there but not that evident with everyday life except on a somewhat longer walk or climbing stair.
The most impressive thing she told (advised) me to give an injection in back, there will be (anaesth/ Numbness), no pain ,in lower part, ( do not know from where she got he idea). let the heart stay in its place and have its problem...
I smiled at her idea. Tried to convince with examples, how heart reacts to any thing that happens in body inside and outside. Finally she agreed that I am the one to give her anaesth.. and she is ready.
What should be my plan of Anaesth ?
Low Spinal minimal fall of BP,or GA with drugs that least interfere the cardiac function ?
After 2 weeks I decided to go for a low spinal anaesthesia T12 and below
In a sitting position 2 mo Heavy Bupivicaine +Fentanyl 50mcg injected at L2-3
BP on table before 180/ 111, but settled at 130/80 .An inj Midazolam 3 mg IV made her sleep well.
Rest were uneventful.
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