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Volume 27, Issue 132, February 2023

Anaesthetic challenges in a case of psoas abscess with discovertebral destruction at lumbar vertebral level with severe mitral regurgitation, severe aortic regurgitation and extrapulmonary tuberculosis

Sambit Dash¹, Roshan Nisal², Vivek Chakole³, Aruna Chandak⁴

¹Junior Resident, Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research (Deemed University), Wardha, Maharastra, India
²Assistant Professor, Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research (Deemed University), Wardha, Maharastra, India
³Professor and Head of Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research (Deemed University), Wardha, Maharastra, India
⁴Professor, Department of Anesthesiology, Jawaharlal Nehru Medical College, Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education & Research (Deemed University), Wardha, Maharastra, India

ABSTRACT

It is recommended to take a cautious approach when vertebral lesions are discovered in one or two vertebrae but there is no significant disruption in the vertebral stability. We describe a 38-year-old male with Pott's disease of the lumbar spine with extensive psoas abscesses. The patient also had multiple ground glass opacities in right lungs, along with severe aortic regurgitation and mitral regurgitation. The patient was started on anti-tubercular therapy. On the day of surgery, he was induced under general anaesthesia with central venous catheterization and arterial canulation for better haemodynamic management. The abscess was drained in a prone position followed by fixation of the spine. The anaesthetic management was a challenge because of multiple issues the patient had, be it the psoas abscess, extrapulmonary tuberculosis, bad lung mechanics and cardiac changes. An appropriate preoperative assessment and judicious intraoperative planning and management could help us handle the case smoothly. Postoperatively the patient was extubated on the table and shifted to intensive care for observation and further management.

Keywords: Psoas Abscess, Pot’s Spine, Mitral Regurgitation, Aortic Regurgitation, Extrapulmonary Tuberculosis.