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ANAESTHETIC DILEMMA: EMERGENCY KNEE ARTHROSCOPY IN PATIENT WITH DILATED CARDIOMYOPATHY AND COAGULOPATHY
Author(s): ,
Singh, M.*
Affiliations:
New Cross Hospital- Wolverhampton, Anaesthetics, Wolverhampton- WV10 0QP, United Kingdom
Khan, M.
Affiliations:
New Cross Hospital, Anaesthetics, Wolverhampton- WV10 0QP, United Kingdom
ESRA Academy. Singh M. Sep 16, 2017; 196150; esra7-0023
Dr. Manpreet Singh
Dr. Manpreet Singh
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Abstract
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Background and Aims:

A 47year old male with septic knee arthritis was posted for knee arthroscopy, washout and debridement. Preoperatively, BP was 94/64 mm Hg, H.R 90 beats/min, Spo2 97% on air, R/R 17/min and temperature of 38.3°C.

Medical history comprised of congenital adrenal hyperplasia and dilated cardiomyopathy. Latest ECHO suggested LVEF of 10-15%, left atrial thrombus 2.4×1.5 cm, severe MR with dilated LA, moderate TR with PASP of 42mmHg, moderate PR, dilated RV with severely reduced function.

Medications included dexamethasone, fludrocortisone, hydrocortisone, amiodarone, bisoprolol and warfarin. INR was 2.5, Hb 96g/L, WBC- 8.7×109/L, platelets 356×109/L, Na130mmol/L, K 4.8mmol/L, urea 6.1mmol/L, creatinine 75µmol/L, CXR moderate cardiomegaly and ECG showed LBBB.

Methods:

We planned to do this case under femoral and popliteal nerve blocks. Informed consent was obtained, standard monitoring attached and arterial line inserted. Under aseptic conditions and HF ultrasound guidance (Sonosite), both nerves were blocked using 21G 100mm needle.  Total dose of 30mls L-bupivacaine 0.375% was used, with aspiration every 5mls without any pain on injection. Sensory block was checked with cold ethyl chloride spray and pinprick.

Results:

Patient was haemodynamically stable throughout the procedure, later being transferred to the ICU with an uneventful recovery. We avoided the ill effects of GA/neuraxial block and successfully did this case, purely under regional anaesthesia.

Conclusions:

Anaesthetist needs to have good understanding of complex medical conditions and its implications. We conclude that knee arthroscopy can be safely done with combined femoral-popliteal block in patient with dilated cardiomyopathy on warfarin.

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