Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000400008
Brazilian Journal of Anesthesiology
Clinical Information

Lesão da artéria ilíaca esquerda durante laminectomia lombar: relato de caso

Left iliac artery injury during lumbar laminectomy: case report

Wanderley Rodrigues Moreira; Hélio Humberto Cançado Xavier

http://dx.doi.org/10.1590/S0034-70942003000400008 Braz J Anesthesiol, vol.53, n4, p.489-495, 2003
PDF
Downloads: 0
Views: 1016

Resumo

JUSTIFICATIVA E OBJETIVOS: Lesão da artéria ilíaca é uma ocorrência rara em laminectomias, porém, muito grave. O objetivo deste relato é apresentar um caso de lesão da artéria ilíaca esquerda, em paciente submetido a laminectomia lombar sob raquianestesia, que se manifestou clinicamente no pós-operatório imediato, sete horas após o início da cirurgia. RELATO DO CASO: Paciente do sexo masculino, estado físico ASA I, 31 anos, 68 kg, foi submetido à laminectomia lombar em decúbito ventral sob raquianestesia em L2-L3, com bupivacaína hiperbárica a 0,5% (20 mg) e fentanil 25 µg. A cirurgia transcorreu normalmente e sete horas após o seu início, já no pós-operatório, o paciente apresentou hipotensão arterial, taquicardia, agitação e dor abdominal difusa. A tomografia abdominal mostrou aspecto compatível com hematoma retroperitoneal e a laparotomia exploradora revelou lesão da artéria ilíaca comum esquerda. Após a laparotomia, o paciente evoluiu bem. CONCLUSÕES: Na dependência do posicionamento e do estado físico, técnicas de anestesia geral se impõem. O caso chama atenção para o fato de que qualquer técnica anestésica que tenha sido realizada, o sangramento no campo operatório pode não ser real, na vigência de uma lesão vascular, porque este sangramento pode ser tardio. No presente caso, a manifestação clínica ocorreu sete horas após o início da cirurgia, quando o paciente já estava recuperado da anestesia. No entanto, o fenômeno (hipotensão arterial) poderia ter ocorrido no per-operatório.

Palavras-chave

CIRURGIA, CIRURGIA, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Iliac artery injury during laminectomy is an uncommon, however very serious event. This report aimed at presenting a case of left iliac artery injury in patient submitted to lumbar laminectomy under spinal anesthesia, that was clinically manifested in the immediate postoperative period, seven hours after beginning of surgery. CASE REPORT: Male patient, physical status ASA I, 31 years old, 68 kg, submitted to lumbar laminectomy in prone position under spinal anesthesia in L2-L3 interspace with 20 mg 0.5% hyperbaric bupivacaine and 25 µg fentanyl. Surgery went on normally and seven hours after its beginning, already in the postoperative period, patient presented arterial hypotension, tachycardia, agitation and diffuse abdominal pain. An abdominal CT-scan showed extensive retroperitoneal hematoma and exploratory laparotomy revealed left iliac artery injury. After laparotomy, patient recovered without intercurrences. CONCLUSIONS: General anesthesia is mandatory depending on patients’ positioning and physical status. This case calls the attention to the fact that regardless of the anesthetic technique, there might be no operative field bleeding in the presence of vascular injury because this bleeding may be late. In our case, clinical manifestation was seven hours after beginning of surgery, when the patient had already recovered from anesthesia. However, the event (arterial hypotension) could have happened in the intraoperative period.

Keywords

ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, COMPLICATIONS, SURGERY, SURGERY

References

Yeng AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome and complication in 307 consecutives cases. Spine. 2002;27:722-731.

Komori H, Shinomiya K, Nakai . The natural history of herniated nucleous pulposus with radiculopaty. Spine. 1996;21:225-229.

Frohilich M, Ahrens S, Hasenbring M. Predictors of bad and good outcome of lumbar spine surgery: a prospective clinical study with 2 years’ follow-up. Spine. 1996;21:1056-1064.

Wood II GW. Lower Back Pain and Disorders of Intervertebral Disck. Campbell’s Operative Orthopaedics. 1992:3715-3790.

Maroon JC, Onik G, Young P. Treatment of Lumbar Disck Protrusion with Unilateral Radiculopathy: Percutaneous Aspiration Discectomy vs Microdiscetomy vs Conservative Treatment. Controversies in Neurosurgery. 1996:251-258.

Quigley MR, Maroon JC. Intradiscal Treatment of Lumbar Disck Disease. Neurological Surgery. 1996;3:2382-2389.

McCormick PC. Intervertebral Discs and Radiculopthy. Merritt’s Neurology. 2000:424-430.

Parsa AT, Miller JI. Neurosurgical Diseases of the Spine and Spinal Cord: Surgical Considerations. Anesthesia and Neurosurgery. 2001:531-555.

Stolke D, Sollmann W-P, Steifert V. Intra-and postoperative complications in lumbar disc surgery. Spine. 1989;14:56-59.

Friedman J, Whiteclound T. Lumbar cauda eqüina syndrome associated with the use of geofoam: case report. Spine. 2001;26:E485-487.

Ramirez LF, Thisted R. Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals. Neurosurgery. 1989;25:226-231.

Langmayr JJ, Ortler M, Obwegeser A. Quadriplegia after disc surgery. Spine. 1996;21:1932-1935.

Friedman J, Ecker R, Piepgras DG. Cerebellar hemorrhage after spinal surgery: report of two cases and literature review. Neurosurgery. 2002;50:1361-1364.

Goodkin R, Laska LL. Vascular and visceral injuries associated with lumbar disc surgery: medicolegal implications. Surg Neurol. 1999;51:230-237.

Kardaun JW, White LR, Shaffer WO. Acute complications in patients with surgical treatment of lumbar herniated disc. J Spinal Disordes. 1990;3:30-38.

Bostman O, Hyrkas J, Hirvensalo E. Bloss loss, operating time, and positioning of the patient in lumbar disc surgery. Spine. 1990;15:360-363.

Prabhu M, Samara S. An unusual cause of rhabdomyolysis following surgery in the prone position. J Neurosurgery Anesthesiology. 2000;12:359-363.

Baywa A, HO C, Grush A. Discitis associated with pregnancy and spinal anesthesia. Anesth Analg. 2002;94:415-416.

Brown MD, Levi AD. Surgery for lumbar disc herniation during pregnancy. Spine. 2001;26:440-444.

Laakso E, Ahovuo J, Rosenberg PH. Blood flow in the lower limbs in the knee-chest position. Anesthesia. 1996;51:1113-1116.

Bhardwaj A, Long DM, Ducker TB. Neurologic deficits after cervical laminectomy in the prone position. J Neurosurgical Anesthesiology. 2001;13:314-319.

Hatmannsgruber MWB, Atanassoff PG. Regional anesthesia versus general anesthesia: Does it make a difference?. ;17:58-63.

Sprung J, Bourke DL, Grass J. Predicting the difficult neuraxial block: a prospective study. Anesth Analg. 1999;89:384-389.

Weglinski MR, Berge KH, Davis DH. New onset neurologic deficts after anesthesia for MRI. Mayo Clin Proc. 2002;77:101-103.

Brewster DC, May ARL, Darling C. Variable manifestations of vascular injury during lumbar disk surgery. Arch Surg. 1979;114:1026-1030.

Birkeland IW, Brodner KF. Major vascular injuries in lumbar disc surgery. J Bone Joint Surg.. 1969;51:119-124.

Ewah B, Carlder I. Intraoperative death during lumbar discetomy. Br J Anaesth. 1991;66:721-723.

Mirzai H, Tekin I, Alincak H. Perioperative use of corticosteroid and bupivacaine in lumbar disc surgery: a randomized controlled trial. Spine. 2002;27:343-346.

Hönemann CW, Brodner G, Aken HV et al. Aortic perforation during lumbar laminectomy. Anesth Analg. 1998;86:483-485.

Hoff-Olsen P, Wiberg J. Small bowel perforation as complication of microsurgical lumbar diskectomy: a case report and brief review of the literature. Ame J Forensic Med & Pathol. 2001;22:319-321.

Moore CA. Combined arterial, venous, and ureteral injury complicating lumbar disk surgery. Am J Surg. 1968;115:574-577.

Stokes JM. Vascular complications of disc surgery. J Bone Joint Surg. 1968;50:394-399.

Kiev J, Dupont JR, Kerstein J. Injury of a medial sacral vessel during lumbar laminectomy. Ann Vasc Surg. 1996;10:63-65.

Abad C, Martel D, Feijoo JJ. Major vascular following surgery for a herniated lumbar disck. Angiologia. 1993;45:170-173.

Bashkoff E, Gadaleta D, Moccio C. Postlaminectomy aortic pseudoaneurysm. J Spinal Disord. 1992;5:219-221.

Smith DW, Lawrence BD. Vascular complications of lumbar decompression laminectomy and foraminotomy: A unique case and review of the literature. Spine. 1991;16:387-390.

Freischalag JA, Sise M, Quimones-Baldrich . Vascular complications associated with orthopedic procedures. Surg Gynecol Obstet. 1989;169:147-152.

Bass Jr J, Lach J, Fegelman RH. Vascular injuries during lumbar laminectomy. Am Surg. 1980;46:649-651.

Halaszynski TM, Hartmannsgruber WB. Anatomy and physiology of spinal and epidural anesthesia. Seminars in Anesthesia, Perioperative Medicine and Pain. 1998;17:24-37.

Hogan QH. Epidural anatomy: new observations. Can J Anaesth. 1998;45:R40-44.

Igarashi T, Hirabayashi Y, Shimilu R. Inflammatory changes after extradural anaesthesia may affect the spread of local anaesthetic within the extradural space. Br J Anaesth. 1996;77:347-351.

Fager CA, Freidberg SR. Analysis of failures and poor results of lumbar spine surgery. Spine. 1980;5:87-94.

Zvara DA, Olympio MA, Frankland MJ. Dynamic left ventricular outflow obstruction during lumbar laminectomy as an unexpected cause of intraoperative hypotension. J Neurosurgery Anesthesiology. 2002;14:146-148.

Shumaker HB, King H, Campbell R. Vascular complication from disc operations. J Trauma. 1961;1:177-179.

Sandozl, Hodges V. Ureteral injury incident to lumbar disk operation. J Urol. 1965;93:687-689.

Benoist M, Ficat C, Baraf P. Postoperative lumbar epiduroarachnoiditis. Diagnostic and therapeutic aspects. Spine. 1980;5:432-436.

Kelly JJ, Reuter KL, Waite RJ. Vascular injury complicating lumbar diskectomy: CT diagnosis. AJR. 1989;153:1233-1234.

Laakso E, Pitänen M, Kyttä . Knee-chest vs horizontal side position during induction of spinal anaesthesia in patients undergoing lumbar disc surgery. Br J Anaesth. 1997;79:609-611.

Anderton JM. The prone position for the surgical patient: a historical review of the principles and hazards. Br J Anaesth. 1991;61:452-453.

Marshall WK, Mostrom JL. Neurosurgical Diseases of the Spine and Spine Cord: Anesthetic Considerations. Anesthesia and Neurosurgery. 2001:557-590.

Nygaard OP, Romner B, Thoner J, Ozkose Z, Ercan B, Ünal Y. Local anesthesia in posterior cervical surgeryInhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamics effects, recovery characteristics, and cost. AnesthesiologyJ Neuros Anesthesiology. 1997;86:242-243.

Jellish WS, Thalji A, Stevenson K. A prospective randomized study comparing short - and intermediate- term perioperative outcome variables after spinal or general anesthesia for lumbar disk and laminectomy surgery. Anesth Analg. 1996;83:559-564.

Greenbarg PE, Brown MD, Pallares VS. Epidural anesthesia for lumbar spine surgery. J Spinal Disorders. 1988;1:139-143.

Tetzloff JE, O’Hare J, Bell G. Influence of baricity on the outcome of spinal anesthesia with bupivacaine for lumbar spine surgery. Reg Anesth. 1995;20:533-537.

Rung GE, Williams DD, Gelb D. Isobaric spinal anesthesia for lumbar disk surgery. Anesth Analg. 1997;84:1165-1166.

Jellish WS, Shea J, Thalji Z. Isobaric spinal anesthesia for lumbar disk surgery. Anesth Analg. 1997;84:1166.

Ditzler JW, Dumke PR, Harrington JJ. Should spinal anesthesia be used in surgery for herniated intervertebral disc?. Anesth Analg. 1959;38:118-124.

Smith DM, Zwerling AJ, Rocco MJ. Spinal anesthesia for lumbar laminectomy: A technique revisited and revised. Reg Anesth. 1995;20:2S:20.

Dilger J, Tetzlaff JE, Bell G. Spinal versus general anesthesia for elective lumbar spine surgery. Reg Anesth. 1997;22:2S:35.

Tetzlaff JE, Dilger J, Bell G. Influence of technique on the outcome of spinal anesthesia for lumbar spine surgery. Reg Anesth. 1997;22:2S:92.

5ddd32820e882507761da3ea rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections