ANAESTHETIC MANAGEMENT OF CHRONIC RENAL FAILURE WITH DILATED CARDIOMYOPATHY POSTED FOR ROBOTIC RENAL TRANSPLANT

Dr.Yogeshkumar Jadav; Dr Megha Prajapati

Volume : VII, Issue : XI, November - 2018

ANAESTHETIC MANAGEMENT OF CHRONIC RENAL FAILURE WITH DILATED CARDIOMYOPATHY POSTED FOR ROBOTIC RENAL TRANSPLANT

Dr. Yogeshkumar Jadav, Dr Megha Prajapati

Abstract :

Introduction: Dilated Cardiomyopathy is defined by presence of Ejection fraction <45% ,Myocardial shortening <25%, Left ventricular dilatation and systolic dysfunction, In ESRD, dilated cardiomyopathy occur due to increased intravascular volume aspatient are oligouric or anuric.

Case report: A 41 Y/F weighting 59kg having chronic renal failure on MHD 2/wk with Hypertension(2017) and dilated cardiomyopathy on regular medication.Her 2D Echo shows:- EF=40%, RVSP=45mmHg, Global LV hypokinesia, severe MR, dilated LV, mild LV dysfunction, mild PAH.Premedication was with Inj. Glycopyrollate 0.2mg and Inj. Fentanyl 100ug. The patient was maintained intra-operatively with infusions of Atracurium.Patient was connected to circle system and maintained with Air : O2 – 2:2 and sevoflurane – 0.8% – 1.5%. 20 min after induction :- BP- 80/50mmHg Arrythmia:- on ECG –ventricular bigeminy- inj.Lignocaine2% given,Inj. Amiodarone 150mg i.v stat given – normal rhythm achieved. Systemic and pulmonary B.P managed by iv NTG Inj. Paracetamol 1gm and tramadol for pain management Urine output established after clamp release.

Conclusion: Anaesthesiologists should be aware of the Optimal understanding of pathophysiology of CKD with DCM coupled with effects of pneumoperitoneum and steep trendelenburg position can enable successful management of such high risk patients.