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Successful Right Hepatectomy Procedure for Giant Hemangioma: A Case Report

This case report outlines the successful right hepatectomy in a 51-year-old patient diagnosed with a giant hemangioma of the liver. The anesthetic management, surgical procedure, intraoperative challenges, and postoperative outcomes are discussed in detail. This report highlights the importance of meticulous planning and prompt intervention in liver resection surgeries.

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Successful Right Hepatectomy Procedure for Giant Hemangioma: A Case Report

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  1. CASE REPORT – RIGHT HEPATECTOMYDr.M.MuthuShenbagam,MD(Anes),DA.Asst.ProfessorDept.ofAnaesthesia,KanyakumariGovt.Medical College Hospital.

  2. 51yrs old Mr. Stephen from Nagercoil,admitted at KGMCH with C/o. Abdominal pain > 6 months.Diagnosed by CT as Giant Hemangioma (Rt) lobe of liver.

  3. INVESTIGATIONS Hb - 10 gms % LFT- WNL Coagulation profile - WNL

  4. Planned for Rt Hepatectomy. • Assessed • Procedure & risk explained to the patients and relatives. • Adequate blood reserved.

  5. Patient was shifted to OT.Started IV lines 2 widebore 16G venflon – Rt&Lt arm. One 18G venflon in LL.

  6. Monitors. - Pulse oximeter - NIBP - ECG - CVP -Urine output

  7. ANAESTHESIA PLAN ETGA + Thoracic Epidural Anesthesia

  8. Emergency drugs ,NTG, Dopamine infusion kept ready.Premed : -Inj.Glycopyrolate 0.2mg IV - Midazolam 2mg IV - Pethidine 50mg IV

  9. Under Asepsis Rt Internal jugular vein cannulated &Triple lumen CVP catheter inserted under seldinger technique & distal port used for CVP measurement.

  10. Under asepsis, RT lat-position, 18G Epidural Catheter inserted in T10-T11space& 5cm kept inside& 10ml of 0.2% Ropivacaine + 25mcg Fentanyl given through Epidural Catheter

  11. INDUCTION : Thiopentone 250mg IVScoline 75mg IVINTUBATION : 8.0 ID Endo tracheal tube & BAE checked

  12. MAINTENANCE – N2O/O2- Fentanyl - AtracuriumLA supplementation thro Epidural.

  13. Fluid- Maintenance with Crystalloids& Colloids.CVP was kept in the range of 4-6 cm water.NTG infusion was used to minimize blood loss.

  14. Vascular control was done with inflow clamping of Hepatic A / portal vein (Pringle maneuver)

  15. Intra operatively, during resection phase, huge blood loss from middle hepatic veins.BP to 60/40mmHg

  16. MANAGEMENT: - Mephentermine 12 mg Bolus - Colloids/Blood 2 units rushed - Dopamine drip - which was stopped after control BP to 100/70mmHg

  17. Rest of the intraop period- uneventfulSurgery lasted for 6 hrs.Blood loss – app. 2 to 3 lit.Intraoperativly 6 units of blood transfused & calcium supplement given.

  18. At the end of procedure – reversal with Neostigmine + GlycopyrolateExtubated awake.Postop period – Vitals – StableShifted to ISCU.

  19. Problems in Liver Resection Long operation time Fluid Shifts Sudden unexpected blood loss Coagulopathy Hypothermia

  20. Low CVP Technique – controversial • Aids surgery • Minimise blood loss • But, increased risk of Airembolism • Potential for Hemodynamic instability if bleeding is sudden & significant

  21. THANK YOU

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