Dr. Harithaapriyadarshini Chadalavada, C17989, Dr. Suryaprakash A.V., Dr. Ravishankar R B
70yr female planned for (LE)SICS.wt60 kgsASAIII physical status,a k/c/o RHD on Rx.ECG-Irregular rhythm & rate,LAD,wideQRScomplexes,ST depressions&avf s/oAF.2Decho showed RHD severely compromised LVEF-33%, GI MS,AS,AR,GrIIMR,TR. Patient taken under severe cardiac risk. Operating eye dilated with tropicamide0.8%w/v& phenylephrine e/d 5%w/v multiple times before surgery. 0.5ml epinephrine 1mg/ml added to 500ml irrigating solution.Case taken under optimal anesthetic monitoring.6ml plain lignocaine peribulbablock given.Towards end, pink frothy sputum & other signs of congestive cardiac failure secondary to accelerated hypertension developed .Immediate anesthetic intervention saved patient from catastrophic consequences.It is prude to avoid adrenaline & phenylephrine through all routes in highrisk cases. Such cases should be taken up with optimal anesthetic monitoring under senior anesthetist & protocols in place for transfer of patients in isolated units in case pt becomes sick unexpectedly