Anaesthesia management of a patient with incidentally diagnosed diaphragmatic hernia during laparoscopic surgery Laparoskopik Cerrahi Sırasında Tesadüfen Saptanan Diyafragma Hernili Hastada Anestezi Yönetimi
Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi, cilt.43, sa.1, ss.50-54, 2015 (Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 43 Sayı: 1
- Basım Tarihi: 2015
- Doi Numarası: 10.5152/tjar.2014.82787
- Dergi Adı: Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi
- Derginin Tarandığı İndeksler: Scopus
- Sayfa Sayıları: ss.50-54
- Anahtar Kelimeler: Traumatic diaphragmatic hernia, anaesthesia, general, oxygen, nitrous oxide
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Diaphragmatic hernia is usually congenital. However, it is rarely traumatic and can stay asymptomatic. In this report, we aimed to present the anaesthetic management of a patient with diaphrag- matic hernia due to previous trauma (14 years ago), which was di- agnosed incidentally during surgery for rectal cancer. The patient (53 years, 56 kg, 165 cm, American Society of Anaesthesiologist (ASA) II), to whom laparoscopic surgery was planned because of rectal cancer, had a history of falling from a height 14 years ago. Preoperatively, the patient did not have any sign except small right diaphragmatic elevation on the chest x-ray. After induction, main- tenance of anaesthesia was continued with sevoflurane and O2/ N2O. The patient was given a 30° Trendelenburg position. When the trochars were inserted by the surgeon, the diaphragmatic hernia was seen on the right part of the diaphragm, which was hidden by the liver. The surgery was continued laparoscopically but with low pressure (12 mmHg), because the patient did not have any haemodynamic and respiratory instability. The patient, who had stable haemodynamic parameters and no respiratory complications during the operation, was transferred to the ward for monitorised care. Traumatic diaphragmatic hernias can be de- tected incidentally after a long period of acute event. In our case, it was diagnosed during laparoscopic surgery. The surgery was com- pleted with appropriate and careful haemodynamic monitoring and low intra-abdominal pressure under inhalational anaesthesia without any impairment in the patient’s haemodynamic and re- spiratory parameters.