Fauzia Bano Farooq, Tipu Sultan.
Anesthetic management of Cardiac Patient for Cataract Surgery.
J Coll Physicians Surg Pak Jan ;13(9):522-3.

A 6-year-old boy, weighing 11 kg, came to us with diagnosis of TOF for the cataract extraction. TOF was diagnosed on echocardiograph showing ventricular septal defect, pulmonary stenosis, transposition of great vessels and right to left shunt. ECG was showing right axis deviation and right ventricular hypertrophy. X-ray chest was normal. Hemotocrit was high (49.3). On examination patient was cyanosed, had clubbing of fingers and toes, wasted thenar muscles, deformed left thumb and protruded sternum. On palpation systolic thrill was present at lower left sternal border. On auscultation chest was clear and systolic ejection murmur was identified. Syrup cephradine (velocef) 250 mg, six hourly, was given prior to the surgery. Patient was kept nil per oral after 12 am and intravenous line was maintained with 20 gauge cannula. Hartmann solution (Lactated ringer`s), 40 ml per hour was given during that period to avoid dehydration. After taking the informed consent, precordial stethoscope and pulse oximeter were applied. Pre-operative pulse, oxygen saturation, blood pressure and respiratory rate were recorded (heart rate 120/min, saturation 70%, blood pressure 100/60 mmHg, respiratory rate 20/min). Child was pre-oxygenated for 5 minutes. Anesthesia was induced with 1 mg of midazolam and 20 mg (2 mg/kg) of Ketamine and laryngeal masks size 2 1/2 was inserted. Anesthesia was maintained throughout the surgery with 100% oxygen and 10 mg of Ketamine boluses. A total of 70 mg of Ketamine was used during surgery. Ventilation was manually assisted; heart rate, oxygen saturation and blood pressure were closely monitored. No significant changes in heart rate, blood pressure and oxygen saturation were noted. Heart rate remained between 120-130/min, blood pressure 100/70 mmHg and oxygen saturation between 90-93%. Total duration of surgery was about 35 minutes. Laryngeal masks was successfully removed after gentle suction and drying mouth without any complication. Patient was covered and room temperature controlled to avoid hypothermia. He was closely monitored in recovery room for an hour. Blood pressure (100/60mmHg), heart rate (122/min), respiratory rate (20/min) and GCS (Glasgow coma scale) 15/15 were recorded. He was shifted to ward for uneventful recovery.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com