Ultrasound-guided transversus abdominis plane block in combination with ilioinguinal-iliohypogastric block in a high risk cardiac patient for inguinal hernia repair: a case report

Background and Purpose: A high risk cardiac patient, ASA IV, was planned for inguinal hernia repair. Since general anaesthesia presented a high risk, anaesthesia was conducted with a transversus abdominis plane (TAP) in combination with ilioinguinal-iliohypogastric (ILIH) block. Material and Methods: A 70-year old male patient with severe CAD and previous LAD PTCA, AVR, in situ PPM and severe MR and TR 3+, was planned for elective inguinal hernia repair. The preoperative ECHO showed IVS dyskinesis with apicoseptal hypokinesis, global EF 42% and grade III diastolic dysfunction. The patient also suffered from hypertension, diabetes mellitus and had severe stenosis of both femoral arteries. Preoperative preparation included IBP monitoring while the TAP block was carried out under ultrasound guidance using an 8 Hertz linear probe. The ilioinguinal and iliohypogastric nerves were identified with ultrasound and peripheral nerve stimulator. Local anaesthetic [0.5% levobupivacaine (Chirocaine®, Abbott Laboratories) ] was applied in two locations: in the upper right fascia of the transversus abdominis muscle (15 ml) and around the right ilioinguinal and iliohypogastric nerves (10 ml), totalling a volume of 25 ml. Skin infiltration was performed with 5 ml 2% lidocaine [Lidocaine ®, Belupo] and 5 ml of normal saline. Results: Sensory block onset was at 28 minutes after administration and lasted for approximately 18 hours. There were no haemodynamic disturbances and the perioperative course was uneventful. Conclusion: During the first 18 postoperative hours, the patient was comfortable and satisfied with the anaesthetic procedure

Short- and long-term outcome of patients aged 65 and over after cardiac surgery

To analyze the short and long-term outcome of patients aged 65 years and over, after cardiac surgery. Over a 12-year period we analyzed 1750 patients with a mean age of 70.09 3.94 years. They were classified into three age groups: between 65 and 69 (n = 709), between 70 and 74 (n = 695) and 75 years and above (n = 346). Follow-up information was obtained by telephone conversation after a 6-month and 3-year period of discharge from the hospital. Included in the follow-up were 1235 patients and an interview was conducted with 501 (40.6%) patients or their next of kin. Even though the in-hospital morbidity was highest in the oldest age group, there were no significant differences between groups (p = 0.051). There was no significant difference between groups in the length of hospital stay. The greatest in-hospital mortality was noted in the oldest age group (p = 0.046) compared to patients in the age groups between 65 and 69 and between 70 and 74 years old (p = 0.023 and p = 0.036). In the follow-up study, there was a significantly smaller telephone feedback response in the oldest age group compared to the youngest group (p = 0.003). There were no differences between the groups with respect to mortality and cardiac death after the 6-month and 3-year periods of discharge from hospital. Our data showed that despite a poor short – and long-term outcome in patients aged 75 and over, all patients had an acceptable operative risk