Abstract
Abstract Objective: The aim of this report is to represent the role of the use of bedside ultrasound by the anesthesiologist, offering an individualized approach to the specific condition of the patient, without unnecessary postponement of femur fracture surgical repair in the elderly. Case report: Female patient, 86 years old, hypertensive, victim of trochanteric fracture of the femur, taken to the operating room after being released by cardiology service. A bedside ultrasound exam allowed the identification of aortic stenosis, left ventricular hypertrophy, carotid stenosis, and signs of hypovolemia. From these findings, it was decided to use an ultrasound-guided block of the nerves femoral and lateral cutaneous of the thigh as an anesthetic technique. Conclusions: The use of ultrasound guidance by the anesthesiologist can provide relevant information for individualizing the anesthetic technique, without postponing the surgical intervention, which usually occurs when the patient is referred for complete examination by the specialist.
Keywords
Perioperative medicine, Anesthesia, Femur fracture, Ultrasonography, Echocardiography
Resumo
Resumo Objetivo: Exemplificar o papel do emprego da ultrassonografia à beira do leito pelo anestesiologista e oferecer uma abordagem individualizada para a condição específica do paciente, sem que haja postergação desnecessária de correções cirúrgicas de fraturas de fêmur em idosos. Relato do caso: Paciente feminina, 86 anos, hipertensa, vítima de fratura trocantérica de fêmur, levada ao bloco cirúrgico após liberação cardiológica. O exame ultrassonográfico à beira do leito possibilitou a identificação de estenose aórtica, hipertrofia ventricular esquerda, estenose de carótida e indícios de hipovolemia. A partir desses achados, decidiu-se pelo bloqueio nos nervos femoral e cutâneo lateral da coxa guiado pela ultrassonografia como técnica anestésica. Conclusão: O uso da ultrassonografia direcionada à beira do leito pelo anestesiologista pode fornecer informações relevantes para a individualização da técnica anestésica, sem que haja postergação da intervenção cirúrgica, a qual comumente ocorre quando o paciente é referenciado para exame completo pelo especialista.
Palavras-chave
Medicina perioperatória, Anestesia, Fratura de fêmur, Ultrasonografia, Ecocardiografia
References
Ossendorf C, Scheyerer MJ, Wanner GA. Treatment of femoral neck fractures in elderly patients over 60 years of age - which is the ideal modality of primary joint replacement?. Patient Saf Surg. 2010;20:1-16.
Lee DJ, Elfar JC. Timing of hip fracture surgery in the elderly. Geriatr Orthop Surg Rehabil. 2014;5:138-40.
Jettoo P, Kakwani R, Junejo S. Pre-operative echocardiogram in hip fracture patients with cardiac murmur - an audit. J Orthop Surg Res. 2011;6:49.
Alibhai M, Sharma A, Alibhai MK. Does pre-operative echocardiography delay hip fracture surgery?. Indian J Anaesth. 2013;57:408-10.
Luttrell K, Nana A. Effect of preoperative transthoracic echocardiogram on mortality and surgical timing in elderly adults with hip fracture. J Am Geriatr Soc. 2015;63:2505-9.
Mendez NV, Wharton JA, Leclerc JL. Focused transtho-racic echocardiography in hip fracture surgery patients. Int J Clin Anesthesiol. 2013;1:1013.
Heyburn G, McBrien ME. Pre-operative echocardiography for hip fractures: time to make it a standard of care. Anaesthesia. 2012;67:1189-93.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email