title: Revision of loop colostomy under regional anaesthesia and sedation.
abstract: Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported.
authors.affiliation: Department of Anaesthesiology, Singapore General Hospital, Singapore.
authors.forename: Oriana
authors.initials: O
authors.lastname: Ng
authors.affiliation: Department of Anaesthesiology, Singapore General Hospital, Singapore.
authors.forename: Sze Ying
authors.initials: SY
authors.lastname: Thong
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Claramae Shulyn
authors.initials: CS
authors.lastname: Chia
authors.affiliation: Division of Surgical Oncology, National Cancer Centre Singapore, Singapore.
authors.forename: Melissa Ching Ching
authors.initials: MC
authors.lastname: Teo
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000368:Aged; D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects; D003125:Colostomy / Q000009:adverse effects / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage; D005283:Fentanyl / Q000008:administration & dosage; D006439:Hemodynamics; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage; D010535:Laparoscopy; D008297:Male; D009407:Nerve Block / Q000379:methods; D010149:Postoperative Pain; D011184:Postoperative Period; D015742:Propofol / Q000008:administration & dosage; D011655:Pulmonary Embolism / Q000150:complications; D012086:Reoperation / Q000379:methods*; D013617:Tachycardia, Supraventricular / Q000150:complications; D018084:Ultrasonography, Interventional
chemical_list: D020927:Dexmedetomidine; D007649:Ketamine; D005283:Fentanyl; D015742:Propofol
keywords: abdominal wall surgery; colostomy; ilioinguinal-iliohypogastric; rectus sheath and transversus abdominis plane blocks; ultrasonography-guided regional anaesthesia