Anaesthetic Management for Rt Emphysematous Pyelonephritis with Grade I Hydroureteronephrosis with Perinephric Abscess with Left Lobar Pneumonia

Abstract

ntroduction: A perinephric abscess is usually a complication of urologic infection which results from fat necrosis. Before the era of antibiotics, perinephric abscesses were due to prolonged bacteremia. More than 3/4 of perinephric abscesses are now due to complications of urinary tract infections. Case Report: We present a 71 year old female case with Right Emphysematous Pyelonephritis Grade I Hydroureteronephrosis with left perinephric abscess, left lobar pneumonia posted for bilateral DJ stenting with perinephric drain placement under continuous spinal anesthesia. Presented with H/o lower back pain, associated with fever since 3 days and H/o burning micturition, since 6 months. She is known case of Type 2 DM since 23 years and on Inj. Biphasic Insulin, Tablet vildagliptin, Tablet Dapaglifazone, known case of hypothyroidism and on tablet Thyroxin 50 mg OD in morning. H/o stroke 20 years back right side Upper & lower limb affected. H/o previous appendectomy 20 years back, CT–KKUB suggestive of Emphysematous Pyelonephritis, right side with grade I HUN, left perinephric fat with ill diffused hypodense area in upper lobe of left kidney. Non obstructive left renal calculus 4.0mm. ECG shows RBBB, Saturation was 92% on Roomair, On ABG analysis severe metabolic acidosis found. We planned to administer continuous spinal anesthesia. Patient was explained about the continuous spinal anesthesia & written informed consent was taken. Tablet Alprazolam 0.25 mg, and tablet Rantac, 15 was given previous night and in morning on the day of surgery. Nil per oral is maintained 8 hours before surgery. A 18 Gauge IV cannula was secured, a 5 lead Electrocardiogram, Pulse Oximeter, NIBP and ETCo2 monitoring was done. Under strict aseptic precautions, L3 L4 space was identified and using 18G tuhoy needle, Lumbar puncture is done. Injection Bupivacaine 0.8cc given, block is achieved till T8 level. Surgery was lasted for one and half hour. Vitals were stable. Patient shifted to recovery room and was under observation for an hour, patient was shifted to post operative ward. Conclusion: This is an Original case report, which provide a successful management of anesthesia, of bilateral DJ stenting with perinephric drain placement under continuous spinal anesthesia. Anesthesia Management for Right Emphysematous Pylonephritis with grade I HUN. With perinephric abscess with left lobar Pneumonia.