1 / 9

PERIOPERATIVE MANAGEMENT OF A PARTURIENT WITH PRIOR H/O PULMONARY EMBOLISM AND IVC FILTER IN SITU

PERIOPERATIVE MANAGEMENT OF A PARTURIENT WITH PRIOR H/O PULMONARY EMBOLISM AND IVC FILTER IN SITU. DR.KRANAPPU SOLOMON,DNB PG DR.RENU DEVAPRASATH,DNB (Anesth) DR.V.SANKARASUBRAMANIAN,M.D.(Anesth) DR.JEYASEKHARAN HOSPITAL &NURSING HOME, NAGERCOIL. CASE SCENARIO.

troy-contreras
Télécharger la présentation

PERIOPERATIVE MANAGEMENT OF A PARTURIENT WITH PRIOR H/O PULMONARY EMBOLISM AND IVC FILTER IN SITU

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PERIOPERATIVE MANAGEMENT OF A PARTURIENT WITH PRIOR H/O PULMONARY EMBOLISM AND IVC FILTER IN SITU DR.KRANAPPU SOLOMON,DNB PG DR.RENU DEVAPRASATH,DNB (Anesth) DR.V.SANKARASUBRAMANIAN,M.D.(Anesth) DR.JEYASEKHARAN HOSPITAL &NURSING HOME, NAGERCOIL

  2. CASE SCENARIO • 21 year old primi came to our hospital at 7th month of gestation for antenatal checkup. • Gave past h/o superior sagittal sinus thrombosis 4 years back. • Mild antithrombin III deficiency & was on tab.Warfarin • H/o iliofemoral deep venous thrombosis extending into IVC upto renal veins level. • H/o pulmonary embolism, thrombolysed and prophylactic permanent transjugular IVC filter deployed prior to discharge with oral anticoagulants.

  3. ANTENATAL SCENARIO • As soon as pregnancy was confirmed warfarin was stopped,started on inj.fondaparinux 2.5mg OD sc as per physician advice. • Antenatal checkup continued in our hospital. • Advised to get admitted 3days prior to anticipated time of delivery.

  4. PREOPERATIVE PREPARATION • Coagulation workup done • Adequate fresh blood & fresh frozen plasma arranged • Inj.Fondaparinux stopped 48 hours prior to elective LSCS. • Risk of maternal haemorrhage & recurrent DVT/ PE in the postop. period explained. • Discussed with Obstetrician.

  5. ANESTHETIC MANAGEMENT • Two peripheral IV lines secured • Informed consent obtained for regional anaesthesia • SUBARACHNOID BLOCK • sitting position, • L3-4 level • 27G Quincke needle • Single shot • Drug: 0.5% Bupivacaine 2ml + 0.1mg morphine • Intraop-uneventful • Full term baby delivered

  6. POSTOP.MANAGEMENT • Analgesia lasted for 20 hours. • Inj.Fondaparinux started after 24 hours. • Tab.Warfarin restarted. • PT,INR checked & maintained around 2.5-3.5 • Patient had an uneventful postop. & discharged home.

  7. DISCUSSION Be prepared to take the new role as perioperative physician. Update on new drugs essential -FONDAPARINUX. Patient on anticoagulants: plan early to avoid mishaps. Pregnancy:high risk of DVT/PE IVC Filter. Anaesthetic technique of choice – choose the best technique that suits the patient and of course you.

  8. ANSWERS FOR THE ANTICIPATED PROBLEMS • Maternal bleeding. • Emergency caesarean. • Recurrent DVT/PE. • Dislodgement of IVC filter? • Anaesthesiology Clinics .vol.26,pg.1-22 • Anaesthesiology Clinics of North America. vol.21,pg.99,165 • Evidence-Based Practice Of Anesthesiology. Lee A.Fleisher ,pg.218.

  9. THANK YOU

More Related