Indian Journal of Applied Basic Medical Sciences

Open Access
  • Year: 2013
  • Volume: 15a
  • Issue: 20

A modified anaesthesia protocol for patients undergoing minimal invasive cardiac surgery by right thoracotomy-A single center experience

  • Author:
  • R.M. Thosani1,, B.K. Shah2, H.G. Gandhi3, K. Sharath Kumar4, J. R. Rawal5
  • Total Page Count: 8
  • DOI:
  • Page Number: 82 to 89

1Asst. Professor in Cardiac Anaesthesia, U N Mehta Institute of Cardiology & Research Centre, B. J. Medical College, Ahmedabad -16

2Professor and H.O.D. in Cardiac anaesthesia, U N Mehta Institute of Cardiology & Research Centre, B. J. Medical College, Ahmedabad -16

3Asst Professor in Cardiac Anaesthesia, U N Mehta Institute of Cardiology & Research Centre, B. J. Medical College, Ahmedabad -16

4Assistant Professor, Department of Cardiology, U N Mehta Institute of Cardiology & Research Centre, B. J. Medical College, Ahmedabad -16

5Professor and Head of the Department of Cardiology, U N Mehta Institute of Cardiology & Research Centre, B. J. Medical College, Ahmedabad -16

*Correspondence Address: Thosani R. M., Assistant Professor of Cardiac Anesthesiology, U N Mehta Institute of Cardiology & Research Centre, B. J. Medical College, Ahmedabad -16

Online published on 13 February, 2013.

Abstract

Median sternotomy is a well accepted incision for most cardiac surgical procedures. However due to some obvious advantages, now right thoracotomy incision is preferred for some cardiac surgical procedures. The patient position for right thoracotomy necissitates some modifications in anesthesia protocols. In this study we evaluated the feasibility of this approach in selected procedures.

Between February 2009 and October 2012, 41 patients underwent Cardiac surgery via right thoracotomy. The patients selected for this approach were in ASA Grade-II to III without diabetes or hypertension. The surgeries conducted were Atrial septal defect closure (28 cases), valve replacements (12 cases) and one case of thoracic mass excision. A standardized protocol of anaesthesia induction and maintainence was administered with injection propofol, fentanyl and vecuronium bromide dosed according to the patient's body weight. Tracheal intubation was carried out with Left sided DLT (double lumen tube) followed by single lumen tube after the surgery for post operative ventilation. A cardiac surgery was performed through right thoracotomy in fourth inter costal space with incision of 4 to 6 cm in size. There was no mortality or significant morbidity in any of these patients and there was decreased bleeding and shortened duration of ICU stay.

Feasibility of undergoing complex cardic surgery by lateral thoractomy is shown by our experience and we also observed less bleeding and early post operative recovery and ambulation. The approach was highly accepted for cosmetic reasons also.

Keywords

General anaesthesia, Double lumen tube, TEE