Anaesthetic management for an emergency obstructive femoral hernia repair with dynamic ischemic ECG changes: A case report

Abstract

Obstruction in femoral hernias occurs more frequently than expected. Preoperative coronary syndromes present additional challenges in their anaesthetic management. Here is an example of such a case A 60-year-old female with a BMI of 23.3 presented to us with an obstructed femoral hernia that had developed over the course of one day. There were no comorbidities in her case. Her heart rate was 110 beats per minute, and her blood pressure was 120/70 millimetres of mercury. The ECG showed signs of acute coronary syndrome. The cardiologists advised coronary intervention but postponed it in favour of urgency of the surgical procedure. We used a combined spinal epidural with intrathecal narcotics since this patient was completely asymptomatic with stable hemodynamics. The gangrene gut was resected, and the mesh repair was done. The procedure went smoothly. The repeat ECG was comparable to the preoperative one with normal quantitative troponin tests in the post-operative period. The potassium level was 2.7 meq which was corrected. The ECG became normal after 5 days. We hypothesise that the ECG changes were caused by inexplicit hypokalaemia. We report this case due to the extreme rarity of a strangulated femoral hernia with ACS-like ECG changes that later resolved.