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Hemopericardium-A Rare Adverse Event of Radiofrequency Ablation of Lung
EP32885
Poster Title: Hemopericardium-A Rare Adverse Event of Radiofrequency Ablation of Lung
Submitted on 09 Aug 2020
Author(s): Dr.Shruti Kalli
Affiliations:
This poster was presented at SOAPCCON
Poster Views: 115
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Poster Information
Abstract: A 53 years old female operated case of synovial sarcoma in right proximal thigh & bilateral
lung metstatectomy came with recurrence of metstasis in the left lung posted for radiofrequency
ablation of the lesion. Patient was taken on operating table after confirmation of adequate
starvation, vitally stable, iv was secured in upper limb & IV fluid started. Patient was induced
with fentanyl, propofol, atracurium and the airway was secured with cuffed endotracheal tube
no.7, maintained on inhalationals. Amidst the procedure the patient developed symptomatic
bradycardia upto 30bpm with 77/42mmHg -inj atropine 0.6mg iv given heart rate increased to
158bpm but the blood pressure was remaining persistently low-77/49mmHg, following which
she was fluid resuscitated and given mephentermine boluses. There was no change in the
saturation, peak pressure. Later imaging found underlying hemopericardium which lead to
cardiac tamponade effect leading to hypotension. Pericardiocentesis was done which
immediately improved hemodynamics to 99/66mmHg & pig-tailing drained 250ml blood. RFA
was done & the patient was reversed & extubated, shifted to recovery for observation. On follow
up USG scans and after closure trial which revealed minimal streak of pericardial fluid the pigtail
was removed 2 days after the procedure.
Conclusion-
RFA lung is a procedure done to most of the patients with Ca lung , during the procedure owing
to the proximity to major vessels & heart ,care should be given by adequate visualization of the
needle during the insertion/ manipulation, adequate relaxation of the patient so that there are no
spontaneous breathing efforts during the apnea period given & final most good communication
between the intervention radiologist and the anesthetist about the ongoing events can help us
prevent it.
Summary: Hemopericardium during the radiofrequency ablative procedure is a rare
adverse event which causes cardiac tamponade effect if not attended promptly. Prompt
recognition of cardiac tamponade is critical since the underlying haemodynamic disorder can
lead to death if not resolved by percutaneous or surgical drainage of the pericardium.
References: 1.Triage strategy for Urgent management of cardiac tamponade, European Society of Cardiology; European Heart Journal, 2014
2.Hemopericardium & cardiac tamponade in a patient on dabigatran; Korean Circ Journal, 2016
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