Anesthetic management for reentry sternotomy in a patient with a full stomach and pericardial tamponade from left ventricular rupture

Bryan G. Maxwell, Katherine B. Harrington, Nate E. Kelly

Research output: Contribution to journalArticlepeer-review

Abstract

A 57-year-old man presented with chest pain and shortness of breath 1 month after left ventricular aneurysmectomy and ventricular septal defect closure for post-infarct left ventricular aneurysm and ventricular septal defect. Echocardiography revealed a large recurrent ruptured inferior left ventricular aneurysm with high-velocity flow into a 5 cm posterolateral pericardial effusion. Thirty minutes earlier, the patient had eaten a full meal. Rapid sequence induction was performed with midazolam, ketamine, and succinylcholine. Moderate hypotension was treated effectively and the patient tolerated controlled transition to cardiopulmonary bypass. The ventricular defect was oversewn and reinforced with bovine pericardium. The patient had a difficult but ultimately successful recovery. Options for anesthetic management in the setting of tamponade and a full stomach are discussed, with a brief review of the evidence relating to this clinical problem.

Original languageEnglish (US)
Pages (from-to)51-53
Number of pages3
JournalAnnals of Cardiac Anaesthesia
Volume16
Issue number1
DOIs
StatePublished - Jan 2013

Keywords

  • Full stomach
  • Pericardial tamponade
  • Rapid sequence induction
  • Ruptured ventricular aneurysm
  • Ventricular rupture

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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