Anestesia geral após falha da raquianestesia para procedimento de urgência em paciente com mucopolissacaridose: relato de caso

Fabiano Timbó Barbosa; Eduardo Luiz de Araújo Borges; Roberta Ribeiro Marques Brandão

doi:10.1590/S0034-70942007000600008

Clinical Information

Anestesia geral após falha da raquianestesia para procedimento de urgência em paciente com mucopolissacaridose: relato de caso

General anesthesia after failed spinal block for emergency surgery in a patient with mucopolysaccharidosis: case report

Fabiano Timbó Barbosa; Eduardo Luiz de Araújo Borges; Roberta Ribeiro Marques Brandão

http://dx.doi.org/10.1590/S0034-70942007000600008 Braz J Anesthesiol, vol.57, n6, p.658-664, 2007

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Resumo

JUSTIFICATIVA E OBJETIVOS: As mucopolissacaridoses são grupo heterogêneo de doenças hereditárias que ocorrem devido à deficiência enzimática lisossomal com acúmulo de mucopolissacárides ácidos nos tecidos. A mortalidade perioperatória é de 20% e deve-se principalmente à dificuldade no manuseio das vias aéreas. O objetivo deste relato foi apresentar a conduta anestésica adotada diante de paciente portador de mucopolissacaridose que se apresentou ao centro cirúrgico para realização de intervenção cirúrgica de urgência. RELATO DO CASO: Paciente de 15 anos, sexo masculino, com diagnóstico de mucopolissacaridose, deu entrada no centro cirúrgico para tratamento de hérnia umbilical encarcerada. Após monitorização, foi submetido à anestesia subaracnóidea com bupivacaína hiperbárica na posição sentada. Após identificar falha na raquianestesia, o paciente foi submetido à anestesia geral. A indução anestésica foi realizada com clonidina, fentanil e propofol por via venosa, seguida de intubação sem intercorrências. Após 45 minutos de procedimento cirúrgico, o paciente foi extubado e encaminhado à sala de recuperação pós-anestésica. Lá permaneceu por 12 horas sob observação, recebendo alta para enfermaria sem ter havido intercorrências durante esse período. CONCLUSÕES: No caso em questão, não houve dificuldade no manuseio das vias aéreas. Entretanto, esse é o principal problema encontrado nesse grupo de pacientes, cabendo ao anestesiologista escolher a melhor técnica para garantir adequado manuseio das vias aéreas.

Palavras-chave

ANESTESIA, Geral, COMPLICAÇÕES, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Mucopolysaccharidosis are a group of heterogenous disorders secondary to the deficiency of a lysosomal enzyme, with accumulation of acid mucopolysaccharides in the tissues. It carries a 20% perioperative mortality rate due mainly to difficulties on handling the airways. The objective of this report was to present the anesthetic approach of a patient with mucopolysaccharidosis who presented in the operating room for emergency surgery. CASE REPORT: A 15 year-old male patient with a diagnosis of mucopolysaccharidosis was admitted to the operating room for treatment of an incarcerated umbilical hernia. After monitoring, a subarachnoid block with hyperbaric bupivacaine was performed with the patient in the sitting position. After identifying failure of the spinal block it was changed to general anesthesia. Anesthetic induction consisted of intravenous clonidine, fentanyl and propofol, followed by endotracheal intubation without intercurrences. After a 45-minute surgery, the patient was extubated and transferred to the postanesthetic care unit where he remained under observation for 12 hours, being discharged to the regular ward without intercurrences. CONCLUSIONS: In the case presented here we did not have any difficulties handling the airways. However, this is the main problem in this group of patients and it is up to the anesthesiologist to choose the better technique to guarantee adequate handling of the airways.

Keywords

ANESTHESIA, General, COMPLICATIONS, DISEASES

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Anestesia geral após falha da raquianestesia para procedimento de urgência em paciente com mucopolissacaridose: relato de caso

General anesthesia after failed spinal block for emergency surgery in a patient with mucopolysaccharidosis: case report

Fabiano Timbó Barbosa; Eduardo Luiz de Araújo Borges; Roberta Ribeiro Marques Brandão

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