Abstract

Patients with a carcinoma presents with poor nutrition and comes with major morbidity (65%) and 30 day mortality rate of 4%. Needs multimodal treatment and work up with a multi-disciplinary team with Enhanced Recovery after Surgery (ERAS) protocols.

Our patient, 70 year old male had Hypertension, Ischaemic heart disease and Psoriasis on treatment. His preoperative investigations showed Hb of 7.8 gm%, albumin 2.9g/dl; Echo showed Mild MVP, Grade 2 AR, PASP of 25mm Hg, LV diastolic dysfunction. Others were within normal limits.

Epidural was secured at T9-T10 and GA given. A left sided double lumen tube (35 Fr) was introduced and fixed after confirmation of isolating each lung, patient had hypertension treated with Inj NTG tapered later. Epidural was activated with 8 ml of 0.25 mg Bupivacaine. During mediastinal manipulation, patient went into bradycardia and hypotension; transiently surgery was stopped and IV fluids were given and it settled. Total Blood Loss was 500ml and Replaced with one packed RBC. IV fluids RL, NS were given. Haemodynamics were stable later. After surgery he was extubated and sent to ICU for monitoring. Role of Anaesthesiologists in the perioperative period is very important for preparation, planning, conduct of Anaesthesia, one lung ventilation and for a better outcome.

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