A patient was scheduled to undergo TURP for prostate hypertrophy. On pre-anaesthesia assessment, he gave a history of having hypertension. He was on anti-hypertensives. He had no dyspnea, chest pain or fatigue. He was of good muscular build. His BP was 140/100 mm Hg, and pulse rate was 110/min. Lungs and heart examination revealed no abnormality. All ofthe investigations were within normal limits. He was advised tab Inderal 20 mg tds, and tab Valium 10 mg HS. At the time of anaesthesia, the BP was 110/85 mm Hg, and the pulse was 60/min. He was preloaded with 1000 ml of inj. Ringer’s solution, and 2.5 ml of inj
lignocaine plain 2% was injected intradurally, at L 3-4 space, through G 25 spinal needle, and the proper position was adopted. After 5 minutes, the patient’s BP was recorded as 100/60 mm Hg, and the pulse rate
dropped to 36-42 / min. lnj. Atropine 0.5 mg was administered IV, which transientely raised the pulse to
50 / min. Atropine was repeated twice, but could not raise the pulse rate to the desired level. lnj Haemaccel 500 ml was infused. TURP was allowed to proceed. The patient remained alert and comfortable throughout this procedure.
[WpProQuiz 15]
lnj dopamine and inj dobutamine in infusion were started, which raised BP and pulse rate, but the effect was not proportionate to the rate of infusion. On inquiring, the patient confessed that he had tab Valium 2 mg, so he took 5 tablets of it. When shown, he recognized a tablet of Inderal as of Valium. Medical specialist was called, who advised to shift the patient to Cardiac center. He was inserted a temporary pace maker, observed for 24 hours in ICU and recovered.
