Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000400009
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia em paciente portador de distrofia muscular de Duchenne: relato de casos

Anesthesia for Duchenne muscular dystrophy patients: case reports

Rodrigo Machado Saldanha; Juliano Rodrigues Gasparini; Letícia Sales Silva; Roberto Rigueti de Carli; Victor Ugo Dorigo de Castilhos; Mariana Moraes Pereira das Neves; Fernando Paiva Araújo; Paulo César de Abreu Sales; José Francisco Nunes Pereira das Neves

http://dx.doi.org/10.1590/S0034-70942005000400009 Braz J Anesthesiol, vol.55, n4, p.445-449, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: Este estudo objetiva relatar dois casos de anestesia em pacientes portadores de Distrofia Muscular de Duchenne (DMD), uma doença rara, progressiva e incapacitante, e discutir sobre a conduta anestésica. O comprometimento das funções pulmonar e cardíaca, a possibilidade de ocorrência de hipertermia maligna, a maior sensibilidade aos bloqueadores neuromusculares e o aumento da morbidade pós-operatória são alguns dos desafios enfrentados pelo anestesiologista. RELATO DOS CASOS: O primeiro caso foi o de um paciente pediátrico com diagnóstico de DMD e rabdomiossarcoma, agendado para exérese da lesão e esvaziamento cervical ampliado. Na avaliação pré-anestésica (anamnese, exame clínico e exames complementares) não foram detectadas alterações, exceto pela tumoração cervical. Optou-se pela técnica venosa total, com remifentanil em infusão contínua e propofol em infusão alvo-controlada, sem a utilização de bloqueadores neuromusculares. O procedimento cirúrgico teve duração de 180 minutos, sem intercorrências. O segundo caso foi de um paciente do sexo masculino, 24 anos, com diagnóstico de DMD e colelitíase com indicação cirúrgica, cuja avaliação pré-operatória revelou pneumopatia restritiva grave, com diminuições da capacidade e da reserva respiratórias, sendo necessário o uso de BIPAP nasal noturno. Neste paciente, optou-se pela intubação traqueal com sedação mínima e anestesia tópica, seguida pela técnica venosa total com remifentanil em infusão contínua e propofol em infusão alvo-controlada, sem a utilização de bloqueadores neuromusculares. Ao término, o paciente foi extubado ainda na sala de operações e imediatamente colocado no BIPAP nasal. Encaminhado à UTI, com alta no 2º PO e alta hospitalar no 3º PO. CONCLUSÕES: A anestesia venosa total com infusão contínua de propofol e remifentanil sem bloqueadores neuromusculares constitui-se em opção segura e eficiente nos portadores de DMD.

Palavras-chave

ANESTESIA, ANESTESIA, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Reporting two cases of anesthesia in Duchenne Muscular Dystrophy (DMD) patients, which is an uncommon, progressive and disabling disease, and discussing anesthetic approaches, impairment of pulmonary and cardiac functions, the possibility of malignant hyperthermia, increased sensitivity to neuromuscular blockers and increased postoperative morbidity are some challenges faced by anesthesiologists. CASE REPORTS: First case was a pediatric patient with DMD and rhabdomyosarcoma, scheduled for tumor excision and cervical emptying. During preanesthetic evaluation, history, clinical and additional exams, no changes were detected except for the cervical tumor. We decided for total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. Surgery lasted 180 minutes without intercurrences. The second case was a male patient, 24 years old, with DMD and cholelithiasis with surgical indication who, during preoperative evaluation, has revealed severe restrictive pneumopathy with decreased capacity and respiratory reserves and the need for nasal BIPAP at night. For this patient we decided for tracheal intubation with minimum sedation and topic anesthesia, followed by total intravenous anesthesia with remifentanil administered by continuous infusion and propofol by target-controlled infusion without neuromuscular blockers. At the end, patient was extubated still in to operating room and nasal BIPAP was immediately placed, being patient referred to the ICU. Patient was discharged from ICU in the 2nd PO day and from hospital in the 3rd PO day. CONCLUSIONS: Total intravenous anesthesia with propofol and remifentanil administered by continuous infusion without neuromuscular blockers is a safe and effective option for DMD patients.

Keywords

ANESTHESIA, ANESTHESIA, DISEASES

References

Rossbach HC, Lacson A, Grana NH. Duchenne muscular dystrophy and concomitant metastatic alveolar rhabdomyosarcoma. J Pediatr Hematol Oncol. 1999;21:528-530.

Tonelli D, Pinho I, Sacco PCN. Anestesia em paciente com distrofia muscular de Duchenne: Relato de caso. Rev Bras Anestesiol. 2003;53:392-393.

Stevens RD. Neuromuscular disorders and anesthesia. Curr Opin Anaesth. 2001;14:693-698.

Gregory J, McGoldrick KE. Anesthetic implications of neuromuscular disease. Surv Anesthesiology. 2004;48:213.

Le Corre F, Plaud B. Neuromuscular disorders. Curr Opin Anesthesiol. 1998;11:333-337.

Martz DG, Matjasko MJ. Neurological Diseases. Anesthesia and Uncommon Diseases. 1998:3-29.

Morgan JM, Eissa A, Barker I. Comparison of intubating conditions in children after induction of anesthesia following propofol and suxamethonium with propofol and remifentanil. Paediatr Anaesth. 2004;14:707.

Blair JM, Hill DA, Wilson CM. Assessment of tracheal intubation in children after induction with propofol and different doses of remifentanil. Anaesthesia. 2004;59:27-33.

Leone M, Rousseau S, Avidan M. Target concentrations of remifentanil with propofol to blunt coughing during intubation, cuff inflation and tracheal suctioning. Br J Anaesth. 2004;93:660-663.

Capozzoli G, Auricchio F, Accinelli G. Total intravenous anaesthesia without muscle relaxants in a child with diagnosed Duchenne muscular. Minerva Anesthesiol. 2000;66:839-840.

Halsall PJ, Ellis FR. Malignant hyperthermia. Anaesth Intensive Care Med. 2002;3:222-225.

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