AnesthesiawithCardiacTamponade.pptVIP

Anesthesia with Cardiac Tamponade By R3黃信豪 Brief history (1) A 1 y/o female patient, about 10.9 kg. Congenital VSD was diagnosed at birth. VSD repair was performed in 93-07-26 in NTUH. No residual VSD was noted in f/u TTE report. Brief history (2) Poor appetite and daily activity decreased were noted for 3 days. Patient was sent to 金門縣立醫院, and pericardial effusion was told. So patient was transferred to our hospital in 93-08-11. Patient was admitted at 4C2 ICU, and TTE was performed immediately. Pericardial effusion was confirmed, so emergent operation for effusion drainage was arranged. Brief history (3) Patient was sent to OR with A-line inserted and a 24G peripheral line. HR was about 135-150 per min. BP was around 100/60 mmHg without any inotropic agent, and would be dropped to 85/50 mmHg when she calmed down. SpO2 was about 98-100. No cyanosis or jugular vein engorged was noted since patient came to the hospital. Brief history (4) After CVS doctors arrived, induction was performed. medication: Ketamine 25 mg Atropine 0.1mg Nimbex 3 mg intubation: with 5.0 ET tube fixed 13 cm checked by stethoscope After intubation, ventilator was used. Brief history (5) The HR was kept around 120-140 per min. The BP was around 90/60 mmHg. SpO2 was still about 100. pericardiotomy via subxiphoid approached for effusion drainage was performed immediately. About 50 ml clear and yellowish fluid was drainage. Then BP was elevated to 120/ 70 mmHg after the procedure. After replacing a chest tube in pericardial space for drainage, the wound was closed. Then patient was sent to 4A2 ICU for further care. Discussion Definition Cardiac tamponade: the accumulation of fluid in the pericardium in an amount sufficient to cause serious obstruction to the inflow of blood to ventricle results in cardiac tamponade. The three principal features of tamponade are: 1.elevation of intracardiac pressures 2.limitation of ventricular fillng