Interesting Case of Ruptured Ectopic Pregnancy Presenting with WPW syndrome.

History

• A 24 year old women who was a known case of WPW syndrome presented to the casualty with

Severe Lower Abdominal pain, Vomiting, Giddiness.

EXAMINATION

• She was pale, Severely dehydrated, Pulse was 170, BP was 80/60, Abdomen was tender and rigidity +, CVS ,RS were normal.

Opinion

• Emergency Ultra sound was done & Obsterician diagnosed Ruptured ectopic Pregnancy.• She was posted for Emergency

Lapratomy.

ANAESTHETIC MANAGEMENT

• Peripheral IV Line was secured with 14 G and 16 G needle,

• Patient was resuscitated with blood transfusion.• Basic Investigations were done, • HB was 5.3, • ECG showed tachy cardia. No arrythmias.

Intra op

• Patient was connected to Basic monitoring,• Premedication Given with Glycopyrolate & Fentanyl• Pre Oxygenated with 100 % oxygen for 5 mins• Induction done with Propofol & Succinyl Choline • Intubated with 7.5 ET Tube bil air entry checked• Maintanence with 50 : 50 N2o & O2, Isoflurane 0.6%

Atracurium • Nil signiicant events intra operatively • All measures were kept ready to manage tachy or brady

arrythmia

Post Op

• Patient was shifted to Surgical ICU post operatively and extubated after full recovery and hemodynamic ally stable.

• Post operatively she developed Hypoxia she was re-intubated and managed with IPPV for one day and extubated next day.

• she recovered well and she was discharged on 10th day.

Complete Diagnosis

• Post operatively we got the old records which showed WPW syndrome post ablation status-

• EPS showed sucessful abalation • Though she was sucessful case of post RF

abalation we treated here as a case of WPW syndrome and took all precaution to prevent complication of WPW syndrome …..

WPW Syndrome

What exactly is WPW syndrome?

Syndrome with• Accessory pathway between atria & ventricle• This results in preexcitationof ventricle• Associated with tachycardia

QRS starts earlyCurve is slurred –going through muscleThis

Discussion

• WPW syndrome --- Post RF abalation status presenting with severe shock for Lapratomy how to manage ?

Thank You