The challenging aspects and successful anaesthetic management in a case of situs inversus totalis

Abstract

Situs inversus totalis is a rare condition with a predicted incidence of one in 10,000 among the general population, the aetiologic factors for which are still not completely understood. In a patient with situs inversus totalis, not just the diagnosis of any acute abdomen pathology is difficult due to distorted anatomy and transposition of thoraco abdominal viscera but equally challenging is the anaesthetic management during the respective surgical procedure. We are reporting a patient who had situs inversus totalis and was operated for open cholecystectomy. The present case report lays an emphasis on the potential difficulties during anaesthetic management and its various implications.

Safe Anesthetic Management and Anesthetic Considerations in a Patient with Situs Inversus Totalis

“…But SIT can coexist with other congenital anomalies, such as cardiovascular, respiratory, digestive system, etc. (6). Also, although SIT is well described by a few medical journals, the anesthetic considerations have not been thoroughly explained.…”

“…Don't hesitate to interrupt, it may save your ineffective CPR time and help in early return of spontaneous circulation (3) 14. Modification in CPR and defibrillation techniques (3,5,6) 15. Prolonged paralysis is reported with succinylcholine in SIT (due to decrease in pseudocholinesterase levels) (3,5,6) 16.…”

“…Modification in CPR and defibrillation techniques (3,5,6) 15. Prolonged paralysis is reported with succinylcholine in SIT (due to decrease in pseudocholinesterase levels) (3,5,6) 16. Kartagener's syndrome is associated with airway anomalies, which may cause difficult laryngoscopy and intubation (3, 4, 6) 17.…”

Laparoscopic Cholecystectomy in Kartagener Syndrome

“…Skilled anesthesist team is required as these patients are likely to have difficult endotracheal intubation, difficulty in administering neuraxial anesthesia due to spinal deformities, and require appropriate selection of anesthetic drugs for induction and maintenance of general anesthesia due to associated cardiovascular anomalies. 7 Postoperatively, these patients need aggressive chest physiotherapy as they tend to retain chest secretions due to ciliary dyskinesia. 8 Laparoscopic cholecystectomy is a technically demanding procedure in situs inversus totalis.…”

Penetrating Thoracoabdominal Trauma in a Patient with Situs Inversus Totalis: A Case Report and Review of the Literature

“…Bajwa et al (24) reported that surgery performed in a patient with SIT had prolonged the postoperative apnea period. This and such similar instances indicate that anesthetists also need to prepare themselves for variations or abnormalities.…”