A Vasoplegic Syndrome Case

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Vasoplegic syndrome is a severe vasodilatory shock characterised by hypotension, tachycardia, normal or elevated cardiac output, decrease in systemic vascular resistance, poor or no response to fluid resuscitation and vasopressor administration [1]. Though it is commonly seen during cardiac surgery, it is also been reported during non cardiac surgery [2,3]. The incidence of vasoplegic syndrome is 8-10% in cardiac surgery [4], and its risk factors include intravenous heparin, beta-blockers, calcium channel blockers, renin angiotensin system antagonists, protamine use, myocardial dysfunction, diabetes mellitus, presence of pre-cardiopulmonary bypass hemodynamic instability, increased duration of cardiopulmonary bypass and ventricular device insertion [5]. We present a case of successful management of vasoplegic syndrome the developed perioperatively following Whipple’s procedure. Report A 76yr old 52kg male, was schedule for Whipple’s procedure for carcinoma head of pancreas. He was a known hypertensive of enalapril and poorly controlled diabetic on insulin. His preoperative investigations were unremarkable except of elevated HbA1C. The proposed procedure was planned under general anaesthesia with thoracic epidural, for which the patient consented. After instituting appropriate monitoring thoracic epidural catheter was placed in T7-T8 interspace before induction of general anaesthesia. General anaesthesia was induced with fentanyl 2mcg. kg-1 and propofol 2mg.kg-1, and

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