03/07/2025
🟢 Anaesthesia Under Extreme Risk — Every Second Was a Gamble with the Heart
📍 Ash Shafi Hospital, Mirpur-10
🗓️ 30/06/2025
✍️ From the Anaesthesia Desk
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👵 Patient: Mrs. Sasunnahr, 65 years
🏠 From Chattogram
📋 Diagnosis: Advanced Squamous Cell Carcinoma of the oral cavity
Involving bilateral buccal, alveolar, lingual mucosa, and anterior tongue
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💉 Scheduled Surgery:
• Wide Local Excision
• Total Mandibulectomy
• Bilateral Supraomohyoid Neck Dissection (SOND)
• Reconstruction with ALT Free Flap
🕘 Expected Duration: ~12hours
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⚠️ High-Risk Comorbidities — A Case Many Would Walk Away From
🫀 Cardiac Profile:
• LVEF: 34% (Moderate LV systolic dysfunction)
• LV Apical Aneurysm with Organized Thrombus
• Regional Wall Motion Abnormalities (RWMA)
• Single Vessel Disease (LAD) — Advised PTCA & Stenting
• Diastolic Dysfunction (Grade I)
• Mild MR, Mild AR, Trace TR
📈 Other Medical Conditions:
• Hypertension — Longstanding, on medication
• Thyromegaly — Euthyroid but airway distortion possible
This combination meant:
🔴 High cardiac risk
🔴 Difficult airway potential
🔴 Increased risk of intraoperative haemodynamic instability
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🚫 Initial Anaesthesia Decision:
I had to decline multiple times.
The patient was not medically fit for such extensive surgery. Risk of cardiac arrest, airway compromise, or uncontrolled BP surges was substantial.
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🗣️ But the Family Made Their Stand:
Despite full disclosure and worst-case scenario counselling, the patient’s sons firmly stated:
“We take all responsibility. We trust you. Please try.”
It was not an easy moment.
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🧠 Anaesthetic Strategy:
• Cardiovascular-friendly induction
• Meticulous BP & ECG monitoring
• High vigilance for myocardial ischemia
• Airway plan adjusted for thyromegaly-related distortion
• Smooth maintenance over 9 hours
• Judicious fluid & opioid balance
• Controlled emergence
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🕊️ Outcome:
🔹 Intraoperative vitals — stable
🔹 Airway — managed safely
🔹 Reversal — uneventful
✨ Alhamdulillah — the best we could hope for in such a risky case.
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🌟 Anaesthesiologist:
Dr. Md. Naheed Rayhan
This case demanded not just skill — but boldness, calm nerves, and total coordination with the surgical team.
The line between life and collapse was paper-thin. Every drug, every second, every breath mattered.
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🔪 Surgical Heroes:
• Dr. Md. Abdul Hannan — Chief Surgeon
• Dr. Md. Mostafizur Rahman Mamun — Reconstruction Lead
• Assistants: Dr. Shibbir, Dr. Sarwar, Dr. Amitesh
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🛏️ Patient is now recovering in the Postoperative Ward under tight monitoring.
🔗 This wasn’t just a case — it was a test of medicine, ethics, teamwork, and faith.
📍 Ash Shafi Hospital, Mirpur-10