Monitored Anaesthesia Care in An One Hundred Years Old Man in NIO&H

Abstract

Case Report:A 100 years old man weighing 45kg, was admitted in National Institute of Ophthalmology and Hospital (NIO&H) with the diagnosis of cataract in right eye. The patient was scheduled for operation under local anaesthetic block. But on the O.T. table,he became restless and noncooperative. The surgical team postponed the operation and planned to do the surgery under general anaesthesia. We did the necessary investigations for general anaesthesia. Patient was found non diabetic, but had anterolateral ischaemia in ECG and cardiomegaly in chest X-ray.Our anaesthetic plan was to do the surgery under sedation with local anaesthetic block (monitored anaesthesia care). On the OT (JBSA 2014; 27(1): 36-38) Immediately it was noticed that his SPO 2 fell down upto 85%. Guedel's airway was put in situ and oxygen administered through face mask 7-8L/min. Within 90 seconds, his SPO 2 increased to 99%. Then the surgical team gave the local anaesthetic block and after few minutes started operation. Throughout the per operative period,patient was given oxygen through nasal cannula 3L/min, his pulse rate remained 62-64/min, BP-140/90 mmHg, SPO 2 -99%. Two incremental doses (10mg) of Inj.Propofol were given in the peroperative period. The total operation time was 25 minutes. After completion of operation ,within ten minutes the patient opened his eyes, responded to vocal command. After one hour, he was shifted to general ward from postoperative ward and discharged from hospital in the next day. His operation was uneventful except oxygen desaturation for 90 seconds which occurred initially. Discussion:The combination of local anaesthesia with intravenous sedative and analgesic drugs is