Lựa chọn phương pháp vô cảm cho phẫu thuật cắt hoại tử ghép da trên bệnh nhân cao tuổi mắc nhiều bệnh nặng kết hợp (Thông báo lâm sàng).

Abstract

Introduction: General anesthesia for necrosis excision in the elderly with the third-degree heart failure, hypertension, diabetes mellitus type II, pneumonia, heart ischemia disease, right coronary artery stenosis, femoral venous thrombosis inserted a filter in inferior vena cava is a challenge for anesthetist because risk of more severe heart failure, myocardial infarction, and stroke can occur during and after surgery.
On December 5^th, 2019, general anesthesia for necrosis excision and skin graft on the case with severe co-morbidities was made successfully.
Case report: An 88-years-old woman had a history of the third-degree heart failure, hypertension, diabetes mellitus type II, pneumonia, heart ischemic disease, right coronary artery stenosis, femoral venous thrombosis inserted a filter in inferior vena cava, bowel obstruction surgery.
On November 28^th, 2019, she was admitted to the intensive care unit in national hospital of burns in condition with consciousness, obesity, body temperature 37.3⁰C, irregular pulse rate 78bpm, blood pressure 170/90mmHg, SpO₂ 99%, spontaneously tracheostomized ventilation, diminished breath sounds on bilateral bases, scattered fine crackles, soft and distensive abdomen. Local injury included 3% total surface body area of necrosis and bad granulation tissue on abdominal wall.
On December 5^th, 2019, necrosis excision and skin graft on abdominal wall under general anesthesia was made.
Conclusion: General anesthesia for necrosis excision and skin graft on the elderly with severe co-morbidities requires detailed physical examination, optimal preoperative preparation, careful general anesthesia planning and intraoperative monitoring. General anesthesia with less hemodynamically affecting anesthetics and sedatives as well as analgesics is an important factor for successful surgical general anesthesia in the case.