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Background and Aims Elderly frail patients with multi-organ failure present a challenge to anesthesiologists during emergency procedures.
Methods 85 years old female patient with acute left upper limb ischemia was posted for emergency exploration with fasciotomy. Her left arm has acute Ischemia following arterial cannulation of the left brachial artery in the intensive care unit. She is a known patient with oesophageal adenocarcinoma, and has a respiratory failure, aspiration pneumonia and lung collapse with bilateral pleural effusion on MV with tracheostomy. She also has IHD, atrial fibrillation on amiodarone infusion and Urosepsis with septic shock on noradrenaline. Her GCS is 9/15. In addition, she also has a history of DM, hypertension and CKD. Blood investigations were done., including CBC, ABG, electrolytes and Renal functions. The case was discussed and the plan implemented with supra-clavicular brachial plexus block with sedation. The patient went into surgery after discussion and consent of the family. The standard monitors and the mechanical ventilator were attached to the patient in the supine position and Inotropic support and amiodarone were continued. The block was done under Ultrasound guided with complete sterile precautions.
Results The surgery was done successfully, and the patient was transferred back to the ICU.
Conclusions US guided nerve block became the cornerstone in many critical surgeries which has made them easier with high stability of vital signs.
Attachment REGIONAL ANESTHESIA FOR EMERGENCY SURGERY FOR CRITICALLY ILL ELDERLY PATIENT (1).pdf