CASE REPORT

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CASE REPORT RIGHT HEPATECTOMYDr.M.MuthuShenba
gam,MD(Anes),DA.Asst.ProfessorDept.of
Anaesthesia,Kanyakumari Govt.Medical College
Hospital.
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51yrs old Mr. Stephen from Nagercoil,admitted
at KGMCH with C/o. Abdominal pain gt 6
months.Diagnosed by CT as Giant Hemangioma (Rt)
lobe of liver.
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INVESTIGATIONS

• Hb - 10 gms
• LFT- WNL
• Coagulation profile - WNL

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

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Patient was shifted to OT.Started IV lines
2 widebore 16G venflon RtLt arm.
One 18G venflon in LL.
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Monitors. - Pulse oximeter - NIBP - ECG -
CVP -Urine output
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ANAESTHESIA PLAN ETGA Thoracic Epidural
Anesthesia
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Emergency drugs ,NTG, Dopamine infusion kept
ready.Premed -Inj.Glycopyrolate 0.2mg IV -
Midazolam 2mg IV - Pethidine 50mg IV
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Under Asepsis Rt Internal jugular vein cannulated
Triple lumen CVP catheter inserted under
seldinger technique distal port used for CVP
measurement.
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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
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INDUCTION Thiopentone 250mg IV
Scoline 75mg IVINTUBATION 8.0 ID Endo
tracheal tube BAE checked
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MAINTENANCE N2O/O2 -
Fentanyl - AtracuriumLA supplementation
thro Epidural.
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Fluid- Maintenance with Crystalloids
Colloids.CVP was kept in the range of 4-6 cm
water.NTG infusion was used to minimize blood
loss.
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Vascular control was done with inflow clamping
of Hepatic A / portal vein (Pringle maneuver)
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Intra operatively, during resection phase, huge
blood loss from middle hepatic veins.BP to
60/40mmHg
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MANAGEMENT - Mephentermine 12 mg Bolus -
Colloids/Blood 2 units rushed - Dopamine drip -
which was stopped after control BP to
100/70mmHg
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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.
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At the end of procedure reversal with
Neostigmine Glycopyrolate Extubated
awake.Postop period Vitals StableShifted
to ISCU.
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Problems in Liver Resection

• Long operation time
• Fluid Shifts
• Sudden unexpected blood loss
• Coagulopathy
• Hypothermia

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

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THANK YOU