Tromboprofilaxia e bloqueio regional

Américo Massafuni Yamashita; Heitor Yassuda

doi:10.1590/S0034-70942001000400012

Review Article

Tromboprofilaxia e bloqueio regional

Thromboprophilaxis and neuraxial blockade

Américo Massafuni Yamashita; Heitor Yassuda

http://dx.doi.org/10.1590/S0034-70942001000400012 Braz J Anesthesiol, vol.51, n4, p.350-366, 2001

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Resumo

JUSTIFICATIVA E OBJETIVOS: No contexto das doenças vasculares periféricas, a doença venosa tromboembólica tem assumido maior importância, à medida em que se apresenta com freqüência e morbi-mortalidade elevadas e, sobretudo, pela possibilidade de alteração de sua evolução quando há reconhecimento e tratamento adequados. O uso cada vez mais freqüente de tromboprofiláticos tornou-se um problema para os anestesiologistas, uma vez que esses agentes têm aumentado a incidência de hematoma espinhal, quando associados a bloqueios regionais. Este trabalho tem o propósito de apresentar aos anestesiologistas, a partir de ampla revisão de literatura, aspectos farmacológicos e bioquímicos dos anticoagulantes mais comumente utilizados e orientações quando houver necessidade de bloqueio regional nos pacientes em esquema de anticoagulação. CONTEÚDO: São apresentadas as características dos diferentes anticoagulantes e implicações no bloqueio regional. No final da descrição de cada fármaco, seguem-se considerações a respeito das recomendações mais importantes. CONCLUSÕES: A realização de bloqueio regional, na vigência de tromboprofilaxia, exige redimensionamento das cautelas, principalmente nos aspectos concernentes à utilização de cateter peridural, punções repetidas e traumáticas; pois, nestes casos, o risco da ocorrência de hematoma espinhal estará aumentado. Adicionalmente, fazem-se necessárias ampla comunicação e preparo das equipes médica e de enfermagem quanto aos pacientes recebendo anticoagulantes, a fim de diminuir os riscos das complicações hemorrágicas. Esses pacientes devem ser monitorizados minuciosamente, a fim de que sejam detectados precocemente sinais incipientes de compressão medular. Se houver suspeita de hematoma espinhal, a confirmação radiográfica deverá ser providenciada imediatamente, devido ao risco de isquemia medular irreversível.

Palavras-chave

TÉCNICAS ANESTÉSICAS, Regional, ANTICOAGULANTES

Abstract

BACKGROUND AND OBJECTIVES: Among peripheral vascular diseases, thromboembolytic venous disease has gained significant importance due to its high frequency, morbidity and mortality, and, moreover, due to the possibility of interrupting its evolution when there is an adequate diagnosis and treatment. The increasing use of thromboprophylaxis has become a problem for anesthesiologists since those agents have increased the incidence of spinal hematoma when associated to regional anesthesia. After a broad literature review, this study aimed at presenting to anesthesiologists the biochemistry and pharmacology of most commonly used anticoagulants as well as recommendations for regional blockade in patients under anticoagulants. CONTENTS: Characteristics of different anticoagulants and regional anesthesia implications are presented. After each drug description there are considerations about the most important recommendations. CONCLUSIONS: Regional anesthesia under thromboprophylaxis demands lots of caution, especially as to the use of epidural catheters and repeated and traumatic punctures because, in those cases, there is an increased risk for spinal hematomas. In addition, communication between the clinical and nursing staff involved in the management of patients receiving anticoagulants is essential in order to decrease the risk for severe hemorrhagic complications. Patients should be closely monitored for early signs of cord compression. If spinal hematoma is suspected, radiographic confirmation must be immediately sought due to the risk for irreversible cord ischemia.

Keywords

ANESTHETIC TECHNIQUES, Regional, ANTICOAGULANTS

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Tromboprofilaxia e bloqueio regional

Thromboprophilaxis and neuraxial blockade

Américo Massafuni Yamashita; Heitor Yassuda

Resumo

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Abstract

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References

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Braz J Anesthesiol