A 66-year-old woman underwent hysterectomy plus bilateral adnexectomy and lymphadenectomy for endometrial adenocarcinoma.
The patient had a history of myotonic dystrophy type I (Type I DM) or Steiners disease on follow-up due to complete AVB, pulmonary hypothyroidism requiring non-invasive mechanical ventilation (NIV) nocturnal digestion, hyperthyroidism
Previous surgical interventions: cholecystectomy by laparotomy 20 years ago and bilateral cataract surgery, both without complications.
- ECG: sinus rhythm.
Ventricular fibrillation.
Complete left bundle branch block.
- chest X-ray: restrictive pattern.
I digest left pleural effusion.
- Spirometry: FEV1 0.88 sec., FVC 1.16 L (49.6%), FEV1/FVC = 0.76.
Blood gas: pH 7.44, PO2 53 mmHg, PCO2 51 mmHg, HCO3 34.6 mmol/l
- blood count: Hb 11.4 g/dl, hematocrit 3 85x1000/μl, Leukocytes 4.6x1000/μl
- Coagulation: prothrombin activity 80%, TTPA 24.8 s.
Upon arrival to the operating room, the patient was normotensive, normothermic and with 99% arterial oxygen saturation 02 in nasal glasses at 3 minutes.
Premedication with benzodiazepines was avoided.
It was decided to perform an intraspinal anesthesia with hyperbaric bupivacaine 0.5%, 9 mg, plus 5 μg fentanyl; the technique was performed without incidents.
In the first hour, paracetamol 1 g IV, metamizole 2 g IV, dexamethasone 4 mg IV, dexketoprofen 50 mg IV and fluid therapy with heater were administered.
During this first hour, resection of the uterus and annexes was performed.
After 100 minutes of iliac and paraaortic lymphadenectomy, the patient complained of pain, so 10 mg of propofol was injected and a bolus of propofol was prescribed (avoiding the use of benzodiazepine).
A total of 40 mg k was used providing satisfactory analgesia without side effects.
Ventilatory mechanics and O2 saturation did not change during the intervention, maintaining as the only respiratory support the therapy already received in plant (O2 in nasal glasses at 3 l/min).
The surgery ended after 150 minutes without any incidence.
In the resuscitation unit, NIMV was established (CPAP at 5 cmH2O), transabdominal percutaneous block (TAP) was performed bilaterally (7.5 ml ropivacaine 0.5% and 7.5 ml ropivacaine 1% rectus abdominis block).
Analgesia was requested for the hospital ward, avoiding opioids, which arrived three hours after admission to the recovery room.
During her stay in the ward, the patient became stable and had controlled pain and was discharged on the fifth day after the intervention.
