Case Report of Hepatopulmonary syndrome in a Cirrhotic Patient: The Anaesthetic concern in Orthopedic Surgery

KC N*, Baral B**, Dhital D**, Adhikari S

Abstract


Introduction: Hepatopulmonary syndrome (HPS) is a pulmonary complication observed in patients with chronic liver disease, attributable to an intrapulmonary vascular dilatation that induces hypoxemia. Every anesthetist should be aware of the possibility of HPS and of related peri-operative risks in hypoxemic patients with liver disease. A 57 years old male patient with chronic liver disease and hepatopulmonary syndrome, secondary polycythaemia, tubercular brain abscess (on antitubercular treatment and phenytoin for seizure disorder) on domicillary oxygen had intertronchenteric fracture of left hip. He underwent closed proximal femur nailing under subarachnoid block with high risk consent. Intraoperative period was uneventful. On second post operative day he developed hepatic encephalopathy grade II –III and was managed with laxatives, diuretics and other supportive measures. His symptoms improved, and medication were adjusted accordingly and discharged on 10th post op day.

Conclusion: An accurate identification of HPS and proper evaluation is important to prepare the patient and the anesthetist himself for a safe anesthesia during the peri-operative period.

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