Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000300011
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia em paciente com Distrofia Muscular de Duchenne: relato de caso

Anesthesia in Duchenne’s Muscular Dystrophy patient: case report

Deoclécio Tonelli; Iglair Pinho; Paula de Camargo Neves Sacco; Eduardo Piccinini Vianna; José Correia de Vasconcellos; Raquel Vasconcelos de Souza; Sidney Umakoshi

http://dx.doi.org/10.1590/S0034-70942003000300011 Braz J Anesthesiol, vol.53, n3, p.392-395, 2003
PDF
Downloads: 2
Views: 1274

Resumo

JUSTIFICATIVA E OBJETIVOS: A distrofia muscular de Duchenne é uma afecção recessiva ligada ao cromossomo X, geralmente diagnosticada na infância, acentuando-se progressivamente até agravar a função respiratória. O objetivo deste relato é apresentar um caso de um paciente com distrofia muscular de Duchenne diagnosticada há 2 anos, submetido à postectomia, sob anestesia geral com cetamina S. RELATO DO CASO: Paciente com 9 anos de idade com Distrofia Muscular de Duchenne diagnosticada há 2 anos, submetido à anestesia geral com levo-cetamina (1,5 mg.kg-1), por via venosa, sob ventilação espontânea assistida manualmente por sistema de Baraka (Mapleson A) e bloqueio peniano com bupivacaína a 0,5% (25 mg). Foram usados monitores de pressão arterial não invasiva, oximetria de pulso, cardioscopia e temperatura esofagiana. No decorrer da cirurgia, o caso evoluiu sem intercorrências, sendo que no período pós-operatório o paciente apresentou alguns episódios de vômitos sem outras alterações significativas. Permaneceu internado por 24 horas, tendo alta hospitalar assintomático. CONCLUSÕES: A avaliação pré-anestésica cuidadosa, o uso de monitorização adequada e medicações que não predisponham o aparecimento de complicações tornam seguro o procedimento em pacientes portadores de Distrofia Muscular de Duchenne e seu pós-operatório.

Palavras-chave

ANESTESIA, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Duchenne’s Muscular Dystrophy is an X-linked recessive disorder, generally diagnosed in childhood, which progressively worsens to degenerate respiratory function. This report aimed at presenting the case of a patient with Duchenne’s Muscular Dystrophy diagnosed 2 years before, submited to postectomy under general anesthesia with ketamine S. CASE REPORT: Male patient, 9 years old, with Duchenne’s Muscular Dystrophy diagnosed 2 years before, submitted to general anesthesia with intravenous levo-ketamine (1.5 mg.kg-1), under spontaneous ventilation manually assisted by Mapleson A Baraka system and penile block with 25 mg of 0.5% bupivacaine. Monitoring consisted of non invasive blood pressure, pulse oximetry, cardioscopy and esophageal temperature. There were no incidents during surgery, and after surgery patient had a few vomiting episodes, without other significant complications. Patient remained in hospital for 24 hours and was discharged asymptomatic. CONCLUSIONS: Very careful pre-anesthetic evaluation, adequate monitoring and drugs not predisposing to complications make surgery and postoperative period safe for Duchenne’s Muscular Dystrophy patients.

Keywords

ANESTHESIA, DISEASES

Referencias

Gaudiche O, Meistelman C. Anesthésie du myopathe. Anesthésie-Réanimation. 1990;36- 657-D-10:6.

Wollinsky KH, Weiss C, Gelowicz M. Preoperative risk assessment of children with Duchenne muscular dystrophy and intra and postoperative course. Med Klin. 1996;91(^s2):34-37.

Oka S, Igarashi Y, Takagi A. Malignant hyperpyrexia and Duchenne muscular dystrophy: A case report. Can Anaesth Soc J. 1982;29:627-629.

Breucking E, Reimnitz P, Schara U. Anesthetic complications: The incidence of severe anesthetic complications in patients and families with progressive muscular dystrophy of the Duchenne and Becker types. Anaesthesist. 2000;49:187-195.

Sethna NF, Sockoff MA. Cardiac arrest following inhalation induction of anaesthesia in a child which Duchenne's muscular dystrophy. Can Anaesth Soc J. 1986;33:799-802.

Chalkiadis GA, Branch KG. Cardiac arrest after isoflurane in a patient with Duchenne muscular dystrophy. Anaesthesia. 1990;45:22-25.

Smith CL, Bush GH. Anaesthesia and progressive muscular dystrophy. Br J Anaesth. 1985;57:1113:1118.

Stelzner J, Kretz FJ, Rieger A. Anesthetic-induced heart arrest: A case report of 2 infants with previously unrecognized muscular dystrophy. Anaesthesist. 1993;42:44-46.

Taguchi A, Takada K, Horiuchi F. Anesthetic management of a patient with Duchenne's muscular dystrophy undergoing radical repair for tetralogy of Fallot. Masui. 1997;46(12):1594-1598.

Mckishnie JD, Muir JM, Girvan DP. Anaesthesia induced rhabdomyolysis: a case report. Can Anaesth Soc J. 1983;30(3PT1):295-298.

Larach MG, Rosemberg H, Gronert GA. Hyperkalemia cardiac arrest during anesthesia in infants and children with occult myopathies. Clin Pediatr. 1997;36:9-16.

Sulllivan M, Thompson WK, Hill GD. Succinylcholine-induced cardiac arrest in children with undiagnosed myopathy: see comments. Can J Anaesth. 1994;41:497-501.

Obata R, Yasumi Y, Suzuki A. Rhabdomyolysis in association which Duchenne's muscular dystrophy: see comments. Can J Anaesth. 1999;46:564-566.

Robinson AL, Jerwood DC, Stokes MA. Routine suxamethonium in children. A regional survey of current usage: see comments. Anaesthesie. 1996;51:874-878.

Dormans JP, Templeton JJ, Edmonds C. Intraoperative anaphylaxis due to exposure to latex (natural rubber) in children. J Bone Joint Surg Am. 1994;76:1688-1691.

Inibitory effects of diazepam and midazolam in Ca and K channels in tracheal muscle of dog. Anesthesiology. 1999;90:330-333.

Schneider V, Eyrich K, Stelzner J. Muscular dystrophy as a risk factor in anesthesia. Versicherungsmedizin. 1992;44:133-137.

Tang TT, Oechler HW, Siker D. Anesthesia-induced rhabdomyolysis in infants with unsuspected Duchenne dystrophy. Acta Paediatr. 1992;81:716-719.

Benton NC, Wolgat RA. Sudden cardiac arrest during adenotonsillectomy in a patient with subclinical Duchenne's muscular dystrophy. Ear Nose Throat J. 1993;72:130-131.

Arnould JF, Bigot A, Steenbeke L. Heart arrest during general anesthesia in a child with unrecognized Duchenne's dystrophy. Ann Fr Anesth Reanim. 1986;5:612-614.

Fiacchino F, Bricchi M, Gemma M. Pre and postoperative evaluation of plasma creatine kinase in 142 children subjected to “uncomplicated” anesthesia in muscle biopsy. Minerva Anestesiol. 1989;55:11-19.

Aminoff MJ. Nervous System. Current Medical Diagnosis & Treatment. 1999:987-990.

Morgan GE, Mikhail MS. Anesthesia for Patients with Neuromuscular Disease. Clinical Anesthesiology. 1996:650-655.

5ddd38f80e8825ac111da3e9 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections