Anaesthetic management of a case of multiple splenic abscesses with left hydropneumothorax undergoing splenectomy with pigtail catheter insiitu

Abstract

The use of a thoracostomy chest tube for drainage of hydropneumothorax is preferred from an anaesthetic point of view as positive pressure can be applied. Pigtail catheters are widely used as it is less invasive, less traumatic, and easier to perform and allows more ambulation. When compared to the chest thoracostomy tube, pig tail catheters are better tolerated. Here we present a case of a 43 year old man with multiple splenic abscesses in sepsis and left sided hydropneumothorax which was drained with a pigtail catheter. The plan initially was to perform the procedure under high thoracic epidural with ICD on standby. Half an hour into the procedure, due to incessant cough and movement, there was a need to supplement with general anaesthesia using a supraglottic airway (Proseal LMA size 3). The patient was on spontaneous ventilation with Propofol sedation using TCI pump. Procedure was conducted without further complications. Patient was shifted to SICU for further care.