| Abstrakt: |
Background: Hydatid cyst is an infection of echinococcus granulosus. The incidence of the disease is 50-400 per 100,000 people and its incidence is 3.4 per 100,000 people in Türkiye. We aimed to discuss the anesthesia management of liver cold ischemia period and anaphylaxis due to rupture of hydatid cyst during excision of giant cyst invading liver and main vascular structures. Case: A 42-year-old female patient was admitted with the complaints of right upper quadrant pain and fullness. She was diagnosed with VCI in the 7th and 8th segments of the liver, right hepatic vein and alveolar hydatid cyst invading the diaphragm, and right hepatectomy and vena cava resection surgery was planned with in situ hypothermic perfusion without venovenous bypass.. Preoperative preparation was made. The patient was taken to the operating table and routinely monitored. ESP block was performed at the bilateral T8 level. The patient was intubated and connected to the MV after general anesthesia. Hemodynamic monitoring was provided with mostcare monitoring. Since vena cava resection was planned for the patient, left IJV central catheterization was performed. Fluid responsiveness and maintenance were adjusted according to mostcare hemodynamic data. Pheniramine maleate, methyl prednisolone and pantoprazole were administered prophylactically. Before the anhepatic phase was passed, NAC, vitamin c, and magnesium were administered. Anaphylaxis developed after the rupture of the diaphragmatic cyst during resection at approximately 40 minutes. At this stage, the anhepatic phase was exited by placing a graft in the inferior vena cava. A decrease in SV and SVR was observed in Mostcare, and an increase in SVV and PPV was observed. The patient, who did not respond to crystalloid colloid and blood products and fluid resuscitation, was taken to the intensive care unit with noradrenaline, dopamine dobutamine, adrenaline support and chest tube. The patient, whose supports were stopped on the 3rd postoperative day, was extubated on the 5th day, and his vital parameters were stable in the service follow-ups, and he was discharged with recovery on the 16th postoperative day. Conclusion: Our patient developed anaphylaxis due to cyst rupture. Avoiding excessive swelling of the cyst and gentle manipulation can prevent anaphylactic reactions. [ABSTRACT FROM AUTHOR] |
