79-year-old man for laparoscopic Right Hemicolectomy on a background of Caecal cancer
Background:
- COPD – Current Smoker
- Pulmonary Fibrosis – New diagnosis on staging CT
- Multiple previous abdominal surgeries including AAA repair and aorto-bifemoral bypass grafting
- Alcohol excess
- Impaired fasting glucose
Issues:
- Surgical concern regarding the potential difficulties or laparoscopic surgery and chance of having to open
- PFT’s – significantly reduced TLCO = 16% and FEV1/FVC = 0.53 in setting of COPD and new diagnosis of pulmonary fibrosis
- Asymptomatic, DASI = 5.8. Plays bowls
Discussion:
Epidural Anaesthesia
- High chance of conversion to open
- Multiple risk factors for postoperative pulmonary complications
- Consensus that there are many options for regional anaesthesia if converts to open surgery
- Preoperative discussion with surgeon to confirm best technique for analgesia
Disposition
- Ideally ICU 2 postoperatively given co-morbidities and likely long and difficult surgery/possible open procedure
- Would it be reasonable to proceed if no ICU bed available?
- Consensus was no, this patient should have post-operative HDU as a minimum standard of care
Plan:
- Proceed as planned
- Regional anaesthesia recommended, technique as per surgeon and procedural anaesthetist
- Postoperative ICU 2