Sofia Jaswal

Abstract

Background: In today’s era of the COVID-19 pandemic, post-covid lung sequelae increases the incidence of ventilator-induced lung injury in patients undergoing cancer surgeries. Case: A 68 years old female patient underwent surgery for squamous cell carcinoma lower lip under general anesthesia. 10 minutes after reversal and adequate respiratory efforts, sudden desaturation with high peak airway pressures of 35-40 cmH2O was noticed. Bilateral air entry was markedly reduced with crepitus all over the chest and abdomen with stable hemodynamics. Chest X-ray revealed a bilateral deep sulcus sign suggesting bilateral pneumothorax and subcutaneous emphysema. Bilateral thoracostomy tubes were inserted immediately. The saturation and airway pressure improved, and she was extubated the next day. Retrospectively, a possible history of previous undiagnosed COVID-19 infection was sought and this emphasizes the importance of this history, in the ongoing pandemic. Conclusion: Previous history of COVID-19 predisposes patients to a high risk of ventilator-induced lung injury perioperatively.   Keywords: Ventilator-induced lung injury, Barotrauma, COVID- 19, Pneumothorax, Thoracostomy, Cancer

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Abstract

Ultrasound guidederector spinae plane (ESP) block is effective in thoracoabdominal surgeries for control of postoperative pain. With the increasing use of adjuvants in local anesthetics, the block duration can be prolonged. A 21 year old female patient diagnosed with mediastinal teratoma was planned for resection of tumour through median sternotomy. She was given general anaesthesia with standard drugs. At the end of surgery, patient was given bilateral ultrasound guided ESP block with 10 ml of injection ropivacaine 0.2% with 50 mg tramadol at T5 level on each side. Visual analogue scores (VAS) were in the range of 2-3 for first 24 hours and 1 from 24-48 hours. Patient didn’t demand any analgesic in postoperative period for first 48 hours and was completely painfree. Severe postoperative pain of sternotomy can be controlled effectively by giving ultrasound guided ESP block. Moreover, tramadol is a useful adjuvant to prolong the block duration upto 48 hours. Keywords: Ultrasound guided, Erector spinae plane (ESP) block, Tramadol.

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