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- Title
Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture.
- Authors
Maxwell, Bryan G.; Harrington, Katherine B.; Kelly, Nate E.
- Abstract
A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.
- Subjects
CHEST pain; CARDIAC surgery; ANEURYSMS; ECHOCARDIOGRAPHY; HYPOTENSION; CARDIOPULMONARY bypass; CARDIAC tamponade
- Publication
Annals of Cardiac Anaesthesia, 2013, Vol 16, Issue 1, p51
- ISSN
0971-9784
- Publication type
Article
- DOI
10.4103/0971-9784.105371