Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000300003
Brazilian Journal of Anesthesiology
Scientific Article

Pacientes com seqüelas de poliomielite: a técnica anestésica impõe risco?

Patients with sequelae of poliomyelitis: does the anesthetic technique impose risks?

Daniela Pessini Sobreira Rezende; Mônica Rossi Rodrigues; Verônica Vieira Costa; Érika Carvalho Pires Arci; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942008000300003 Braz J Anesthesiol, vol.58, n3, p.210-219, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: Há questionamento antes da realização da técnica anestésica no neuroeixo nos pacientes com seqüela de poliomielite. Os dados de literatura são escassos. O objetivo desse estudo foi descrever as técnicas anestésicas realizadas em pacientes submetidos a procedimentos cirúrgicos e eventuais complicações. MÉTODO: Estudo retrospectivo de pacientes com seqüelas de poliomielite, submetidos a operações, por um período de cinco anos. Avaliados dados demográficos, estado físico (ASA), início da doença, segmento corporal acometido, diagnóstico de síndrome pós-poliomielite, operação e anestesia realizadas, analgesia pós-operatória, complicações intra- e pós-operatórias, acompanhamento ambulatorial e ocorrência de alterações neurológicas. RESULTADOS: Avaliados 123 pacientes submetidos a 162 intervenções cirúrgicas. A maioria dos pacientes (n = 82; 66,6%) apresentava seqüela neurológica em membro inferior. A poliomielite aguda ocorreu em média aos 2 anos e 4 meses de idade. Foram submetidos a operações ortopédicas 87,7% dos pacientes. A técnica anestésica em 64,1% dos casos foi bloqueio em neuroeixo. O bloqueio peridural foi o mais utilizado. Complicações relatadas: punção inadvertida da dura-máter (n = 1; 0,61%), bradicardia (n = 1; 0,61%), hipotensão arterial (n = 2; 1,23%), apnéia e rigidez de tórax (n = 1; 0,61%) no intra-operatório. No pós-operatório, vômitos (n = 2; 1,23%), retenção urinária (n = 4; 2,46%) e síndrome dolorosa complexa regional tipo I (n = 2; 1,23%). O acompanhamento ambulatorial foi de 22 meses, não sendo observada piora neurológica. CONCLUSÕES: Os pacientes com seqüela de poliomielite, submetidos ao bloqueio do neuroeixo não apresentavam qualquer complicação ou piora neurológica no pós-operatório que pudesse ser atribuída à técnica anestésica.

Palavras-chave

ANESTESIA, Geral, DOENÇAS, Neurológica, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Several questions arise before performing neuro-axis block in patients with sequelae of poliomyelitis. Reports in the literature are scarce. The objective of this study was to describe the anesthetic techniques used in patients undergoing surgeries and possible complications. METHODS: We undertook a retrospective study of patients with sequelae of poliomyelitis who underwent surgeries during a five-year period. Demographic data, physical status (ASA), onset of the disease, body part affected, diagnosis of post-poliomyelitis syndrome, surgeries and type anesthesia used, postoperative analgesia, intra- and postoperative complications, outpatient follow-up, and development of neurological changes were evaluated. RESULTS: One-hundred and twenty-three patients who underwent 162 surgical procedures were evaluated. Most patients (n = 82; 66.6%) had neurological sequela in a lower limb. Patients developed acute poliomyelitis at approximately 28 months of age. Orthopedic surgery was performed in 87.7% of patients. Neuro-axis block was used in 64.1% of the cases; epidural block was more frequent. Intraoperative complications reported included: accidental puncture of the dura-mater (n = 1; 0.61%), bradycardia (n = 1; 0.61%), hypotension (n = 2; 1.23%), and apnea and thoracic rigidity (n = 1; 0.61%). Postoperative complications included: vomiting (n = 2; 1.23%), urinary retention (n = 4; 2.64%), and complex regional pain syndrome type I (n = 2; 1.23%). Patients were followed for 22 months and worsening of the neurological disorder was not observed. CONCLUSIONS: Patients with sequelae of poliomyelitis who underwent neuro-axis block did not develop any postoperative complications or worsening of their neurological status that could be attributed to the anesthetic technique used.

Keywords

ANESTHETIQUE TECHNIQUES, Regional, ANESTHETIQUE TECHNIQUES, Regional, ANESTHESIA, General, DISEASES, Neurologic

References

. .

Price RW. Poliomielite. Cecil Tratado de Medicina Interna. 1997:2307-2309.

Lambert DA, Giannouli E, Schmidt BJ. Postpolio syndrome and anesthesia. Anesthesiology. 2005;103:638-644.

Howard RS. Poliomyelitis and the postpolio syndrome. BMJ. 2005:3301314-1318.

Hebl JR, Horlocker TT, Schroeder DR. Neuroaxial anesthesia and analgesia in patients with preexisting central nervous system disorders. Anesth Analg. 2006;103:223-228.

Horlocker TT, McGregor DG, Matsushige DK. A retrospective review of 4767 consecutive spinal anesthetics: central nervous system complications. Anesth Analg. 1997;84:578-584.

Magi E, Recine C, Klockenbusch B. A postoperative respiratory arrest in a post poliomyelitis patient. Anaesthesia. 2003;58:98-99.

Dean E, Ross J, Road JD. Pulmonary function in individuals with a history of poliomyelitis. Chest. 1991;100:118-123.

Janda A. Postoperative respiratory insufficiency in patients after poliomyelitis. Anaesthetist. 1979;28:249.

Jubert B, Agre JC. Characteristics and management of postpolio sydrome. JAMA. 2000;284:412-414.

Liu S, Modell JH. Anesthetic management for patients with postpolio syndrome receiving electroconvulsive therapy. Anesthesiology. 2001;95:799-801.

Reuben SS, Pristas R, Dixon D. The incidence of complex regional pain syndrome after fasciectomy for Dupuytren's contracture: a prospective observational study of four anesthetic techniques. Anesth Analg. 2006;102:499-503.

Hogan CJ, Hurwitz SR. Treatment of complex regional pain syndrome of the lower extremity. J Am Acad Orthop Surg. 2002;10:281-289.

Schott GD. Reflex sympathetic dystrophy. J Neurol Neurosurg Psychiatry. 2001;71:291-295.

Abram SE, Schlicht CR. Tratamento da Dor Crônica. Barash Anestesia Clínica. 2004:1445-1447.

Crawford JS. Epidural analgesia for patients with chronic neurological disease. Anesth Analg. 1983;62:617-621.

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