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Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture


1 Department of Anesthesiology, Stanford University School of Medicine, Stanford, USA
2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

Correspondence Address:
Bryan G Maxwell
Department of Anesthesiology, Stanford University Medical Center, 300 Pasteur Drive, H3586 MC 5640, Stanford, CA 94305-5640
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.105371

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Year : 2013  |  Volume : 16  |  Issue : 1  |  Page : 51-53

 

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A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.






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1 Department of Anesthesiology, Stanford University School of Medicine, Stanford, USA
2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

Correspondence Address:
Bryan G Maxwell
Department of Anesthesiology, Stanford University Medical Center, 300 Pasteur Drive, H3586 MC 5640, Stanford, CA 94305-5640
USA
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.105371

Rights and Permissions

A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.






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