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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims Delivering anaesthesia is very difficult in rural settings, one of the main reasons being the lack of equipment. It has been shown that regional anaesthesia has several advantages for patients with cardiovascular comorbidities. Epidural anaesthesia and analgesia has been described to have many advantages during major surgery, including abdominal surgery.

Methods We present a case in which epidural anaesthesia was used for a patient with auricular fibrillation undergoing laparotomy and for whom no anaesthesia machine nor intensive care unit was available.

Results During a surgical campaign in a village, we received a female patient aged 85 years old, known hypertensive, not observant to treatment, who came for abdominal pain of sudden onset associated to acutely presenting fatigue, with an occlusive syndrome. On physical examination we found an irregular heartbeat, with low blood pressure and clinical signs suggestive of peritoneal irritation. An electrocardiogram done showed atrial fibrillation, and an abdominal ultrasound done was not conclusive. After obtaining patient and family consent, a laparotomy was done with findings warranting resection of ischemic bowel. This was performed under epidural anaesthesia. Per-operative period was marked by hypotension and atrial fibrillation. The postoperative course was uncomplicated.

Conclusions Epidural anaesthesia and analgesia can be beneficial for patients who present with cardiovascular comorbidity and need emergency laparotomy in resource constrained settings where it is not always obvious to perform general anaesthesia.