Target Controlled Infusion Anaesthesia

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  • Target Controlled Infusion Anaesthesia
Pre-surgical anaesthesia assessment is needed for a patient J.Š. (32 years old) due to a gallbladder hydrops. Acute cholecystectomy is planned. The patient mentions a death of a sibling during a surgery under general anaesthesia at a young age (no other information is known). The patient herself has never been under general anaesthesia before. What type of anaesthesia would you choose for this particular patient?

Regional anaesthesia

Wrong answer

In our patient’s case there might be a possibility of malignant hyperthermia and that is why we prefer so called non – trigger anaesthesia. We conceived a suspicion based on family history and because the examination was not performed excluding MH. Also the regional anaesthesia is not appropriate for this type of surgery. It might be used as a part of combined anaesthesia for example as a combination of epidural catheter and general anaesthesia.


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Balanced anaesthesia

Wrong answer

During balanced anaesthesia a volatile liquid or gaseous anaesthetic agents are used. With this type of anaesthesia comes a high risk of triggering malignant hyperthermia therefore in our patient’s case it is contraindicated. We conceived a suspicion based on family history and because the examination was not performed excluding MH.


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TIVA (total intravenous anaesthesia)

Correct answer

Due to the patient’s family history the general anaesthesia in a form of TIVA is indicated (patient with a risk of malignant hyperthermia). We conceived a suspicion based on family history and because the examination was not performed excluding MH. TIVA is a type of non ─ trigger anaesthesia. In this particular case we have decided to use TCI (target controlled infusion) with propofol.
Other drugs (opiates, relaxants), in our case, will be administrated by boluses.


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Analgosedation with the use of local anaesthesia

Wrong answer

Analgosedation with the use of local anaesthesia is not appropriate for this type of surgery. For example we would not be able to use myorelaxants.


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Non-trigger anaesthesia: Anesthesia without the use of pharmacies, which can be a trigger for malignant hyperthermia. These are, for example, volatile anesthetics or succinylcholine.×
 
RR

16 bpm

HR

68 bpm

SpO2

98 %

BP

124/75 mmHg

ECG

sinus rythm, regular pace, BPM 75 bpm

 

Gly

results

ABG

not available

CBC

results

biochemistry

results