Abstract PR055

Abstract

Case report: 39 year old woman with history of metastatic thymoma involving anterior mediastinum and extensive pleural involvement. With disease progression despite treatment with cisplatin, doxorubicin and cyclophosphamide Her course was complicated by Myasthenia Gravis and ICU admission secondary to crisis—treated with IVIG. Presented to UCC in acute distress and found to have cardiac tamponade. Pt taken to OR emergently for decompression of pericardial effusion. Preinduction arterial line, 18G IV x3 in upper/lower extremity. Induction with Ketamine and Succinylcholine—risks of cardiac decompensation thought to outweigh benefit of spontaneous ventilation. Tolerated procedure well. Despite post op PE, patient discharged home within 5 days. CARDIAC TAMPONADE Reduced LV filling hence fixed stroke volume. SNS stimulation to yield increased HR, EF and contractility. Increased SVR to maintain MAP. CO is dependent on HR. Full, Fast and Tight! Avoid bradycardia, vasodilators, attempt optimal volume status. Electrical Alternans, flattened QRS ANTERIOR MEDIASTINAL MASS Extrinsic compression of airway, obstruction of venous return, or obstruction to output of heart. Main concern: intraoperative collapse of tracheobronchial tree—severe hypoxia. Point of compression typically distal to ETT. Inhalation induction maintaining spontaneous ventilation. NMB only after gradually taking over ventilation and ensuring positive pressure ventilation MYASTHENIA GRAVIS Autoimmune disorder of neuromuscular junction. Autoantibodies to ACH receptor cause weakness/fatigue. Treated with ACHesterase inhibitors. Prolonged duration of muscle relaxants. Increased requirement of Succinylcholine. Decreased requirement of non depolarizers. Post op ventilation frequently required.