Redo cardiac valve surgery and severe kyphoscoliosis: Anesth
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A 39-year-old lady, a known case of rheumatic heart disease and post-open mitral valvotomy, presented for double valve replacement (DVR). On examination, she had severe thoracic kyphoscoliosis and difficult airway marked by a Grade IV Mallampati score. Features on chest X-ray were a severe kyphoscoliosis, hypoplasia of the left lung with Cobb's angle measuring 75° [Figure 1]. Pulmonary function test revealed severe restrictive pattern. Transthoracic echocardiogram reported severe aortic stenosis, moderate mitral stenosis, mild mitral regurgitation, and left ventricular ejection fraction of 65%.In operation room, a peripheral venous cannula and an invasive arterial cannula were secured and a standard American Society of Anesthesiologists monitoring was done. Lungs were preoxygenated and standard anaesthetic induction was done. A 6.5 mm endotracheal tube was inserted using a gum elastic Bougie under video laryngoscopy guidance.Redo cardiac surgeries have a multitude of technical challenges. In this patient, anesthesiologists managed these expected difficulties by placing the arterial and venous lines under ultrasound guidance, attaching defibrillator paddles, inotropes loaded, keeping the CPB pump primed, and ready for induction of anaesthesia...

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