Anestesia combinada raqui-peridural em paciente portadora de esclerose lateral amiotrófica: relato de caso

Adriano Bechara de Souza Hobaika; Bárbara Silva Neves

doi:10.1590/S0034-70942009000200008

Clinical Information

Anestesia combinada raqui-peridural em paciente portadora de esclerose lateral amiotrófica: relato de caso

Combined spinal-epidural block in a patient with amyotrophic lateral sclerosis: case report

Adriano Bechara de Souza Hobaika; Bárbara Silva Neves

http://dx.doi.org/10.1590/S0034-70942009000200008 Braz J Anesthesiol, vol.59, n2, p.206-209, 2009

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Resumo

JUSTIFICATIVA E OBJETIVOS: A esclerose lateral amiotrófica é uma doença que se inicia entre a quinta e a sexta década de vida e provoca a degeneração e morte dos neurônios motores superiores e inferiores. Quando os músculos responsáveis pela ventilação são acometidos, o paciente evolui para o óbito em alguns anos em decorrência da insuficiência respiratória. RELATO DO CASO: Sexo feminino, 63 anos, esclerose lateral amiotrófica, submetida a tratamento cirúrgico de fratura transtrocantérica de fêmur. Quadro de fraqueza em membros superiores e inferiores, disartria, consciente e orientada. Aparelho respiratório: tosse ineficaz, diminuição da força dos músculos intercostais e diafragma e redução do murmúrio vesicular em bases pulmonares. Primeiramente, a punção peridural foi realizada em L3/L4, onde um cateter de silicone foi introduzido 5 cm. A seguir, a punção raquidiana foi feita em L4/L5 com administração de 7,5 mg de bupivacaína hiperbárica. Mais 37 mg de ropivacaína a 0,37% foram administrados pelo cateter peridural para que o bloqueio sensitivo alcançasse o dermátomo T10. O procedimento transcorreu sem complicações e a paciente recebeu alta hospitalar após três dias. CONCLUSÕES: As evidências têm demonstrado que a administração de bloqueios no neuroeixo parece ser segura em pacientes com esclerose lateral amiotrófica, pois evita a manipulação das vias aéreas e as complicações ventilatórias.

Palavras-chave

DOENÇAS, Muscular, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Amyotrophic lateral sclerosis starts between the fifth and sixth decades of life, causing degeneration and death of upper and lower motor neurons. When the muscles responsible for ventilation are affected, the patient dies of respiratory failure within a few years. CASE REPORT: This is a 63 years old female with amyotrophic lateral sclerosis who underwent surgical treatment of a transtrochanteric fracture of the femur. The patient presented weakness of upper and lower limbs and dysarthria, and she was awake and oriented. Respiratory function: ineffective cough, decreased strength of the intercostal muscles and diaphragm, and reduction of the breath sounds in both lung bases. Initially, the L3/L4 epidural space was punctured and a silicon catheter was introduced to 5 cm. This was followed by a spinal puncture in the L4/L5 space and the administration of 7.5 mg of hyperbaric bupivacaine. This was followed by the administration of 37 mg of 0.37% ropivacaine through the epidural catheter for a sensitive blockade up to T10. The procedure evolved without complications and the patient was discharged from the hospital after three days. CONCLUSIONS: The evidence has demonstrated that neuroaxis blocks can be safely performed in patients with amyotrophic lateral sclerosis since it avoids manipulation of the airways and respiratory complications.

Keywords

ANESTHETIC TECHNIQUES, Regional, DISEASES, Muscular

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Anestesia combinada raqui-peridural em paciente portadora de esclerose lateral amiotrófica: relato de caso

Combined spinal-epidural block in a patient with amyotrophic lateral sclerosis: case report

Adriano Bechara de Souza Hobaika; Bárbara Silva Neves

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