Consult – 83-year-old lady for consideration of umbilical hernia repair
- Reducible umbilical hernia
- Recent onset intermittent abdominal pain – 1 hospital admission
- CT during last admission revealed AAA with suspicion of leak
- EVAR performed under LA and fentanyl sedation 07/21. Uneventful.
- General surgical team reviewed in hospital and recommended elective repair of hernia
- Severe COPD – Home Oxygen 16 hours per day.
- SpO2 94% on RA. FEV1=0.99, FVC=1.48. TLCP 37%
- Hospital admission 03/21 with infective exacerbation
- Steroid requirement post-EVAR
- DASI=3.9 METs
- NYHA class 3 dyspnoea. Walked approx. 200m on flat at clinic without stopping, profoundly dyspnoeic afterwards.
- Chronic renal impairment – stage 2, deteriorated post-EVAR
Should Surgery Proceed?
- Consensus was yes, recent longer procedure was tolerated well
- Preferable risk profile with elective repair rather than an emergency procedure for a strangulated hernia
Conduct of Anaesthesia
- Patient and surgeon very keen for regional anaesthesia
- Patient very well-informed, understands risks and keen to proceed
- Spinal discussed as an option – most felt it wouldn’t provide suitable analgesia for peritoneal component of surgery
- Options would be spinal or epidural with surgical infiltration to peritoneum or bilateral rectus sheath blocks (recommended option by local regional experts)
- Notably, the patient would be suitable for a short GA if required
- Proceed with surgery
- Discuss meeting recommendations with procedural anaesthetist when allocated.