Анестезия и клинические исследования
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Epidural Anesthesia for Abdominal Laparotomy in an Obese Patient with Severe Cardiac Disease and Epilepsy: A Rare Case Report

Tajera Tageza Ilala

Background: The current practice of regional anesthesia is soundly established for major surgical procedures associated with increased risk of perioperative morbidity and mortality. Particularly, the introduction of epidural anesthesia and analgesia gain a more pronounced acceptance for major surgical procedures including abdominal procedures. Interestingly, low thoracic epidural anesthesia and analgesia is a taken as a golden anesthesia technique in debilitated patients at risk of perioperative cardiopulmonary compromise. Consequently, there exist tremendous advantages of effective epidural anesthesia and analgesia for open abdominal surgery. This facilitate the patient comfort, early ambulation, shorter recovery times, hospital stay, and decreased incidence of cardiopulmonary complications, especially in at risk patient or with underlying cardiopulmonary compromise.

Case description: we presented 38 years old, female obese patient with known congestive heart failure secondary to chronic rheumatic heart disease for the past 3 years and known epileptic patient admitted to our hospital with the diagnosis of abdominal wall hematoma collection. She complained left flank pain and abdominal swelling of 10 days, intermittent dry cough, shortness of breath, orthopnea of 3-pillows and dyspnea at rest of 1 month duration. On physical examination she was acutely sick looked, grade-III holosystolic murmur, cardiopulmonary reserve test of 5 and NYHA class-IV. Abdominal and pelvic ultrasound showed large fluid containing abdominal mass of 16 cm × 1.8 cm × 6.3 cm in size. Chest x-ray revealed the enlarged cardiac shadow with elongation left heart border and bulging of the right heart border and Echocardiography showed the presence of chronic rheumatic heart disease. After we obtained written informed consent, we safely performed low thoracic epidural anesthesia supplemented by rectus sheath for emergency laparotomy.

Conclusion: Patients with multiple comorbid diseases who had limited cardiorespiratory reserves with reduced tolerance to the adverse effects of general anesthesia were more benefited from epidural anesthesia and analgesia during major abdominal surgery.