Laparoscopic Cholecystectomy (1)
60 yrs old male patient came to the camp for Laproscopic cholecystectomy. He had history of Ml 4 yrs back and he was on Tab Aspirin 150 mg. Tab clopact 75 mg OD. Tab Aften 50 OD & Tab Linisopril 2.5 mg OD.
2D Echo revealed LV EF - 35% with inf & lat. wall Myocardial infarction.
This patient was refused by outside doctors because of low EF. Other haemological. Liver function tests and kidney function tests were normal. Patient took anti hypertensive (ACEI) medication early in the morning and premedicated with Inj fentanyl 100 mg, Inj Esmolol 25 mg and nitroglycerin patch.
General anaesthesia was given to patient. Patient was at high risk of intraoperative cardiac failure. This was prevented by keeping systolic blood pressure of around 100-110 mm Hg and heart rate of around 50-60/ min.
Pain also causes tachycardia and it was taken care by local infiltration of bupivacaine and Inj Diclofenac IV.