41-year-old man for consideration of Open Right inguinal Hernia repair

Background

Issues

• Symptomatic right inguinal hernia, contributing to chronic pain
• Intermittent obstructive urinary symptoms
• Severe bullous emphysema – currently being worked-up for double lung transplant
  • Ceased smoking 2 years, 25 pack year history
  • Previous heavy marijuana use – now ceased
  • Pulmonary rehabilitation ongoing, very motivated
  • No hospital admissions with LRTI, no history bullae rupture
  • Formal spirometry: FEV1=2.19 (58%), FVC=3.77 (82%), TLCO=39%
  • 6MWT = 518m – 81% of normal distance for age
• Normal sleep study and Echo
• DASI 6.2MET’s
• Chronic pancreatitis, no alcohol use
• Chronic pain and significant anxiety/depression issues.

Discussion

Timing of surgery

• Consensus that is appropriate to perform hernia surgery prior to transplant
• Patient is experiencing discomfort from hernia and transplant surgery may be years away

Optimisation

• Fully optimised from respiratory perspective, and had all relevant respiratory and cardiac investigations
• Chronic pain is a concern, especially with a view to transplant surgery

Anaesthetic Techniques

• Patient is very keen for regional anaesthesia
• Spinal vs Local infiltration discussed, consensus opinion that either would be a suitableanaesthetic

Plan:

• Proceed to surgery
• Discuss meeting outcomes with surgeon
• Refer to HIPS for chronic pain management