Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000600010
Brazilian Journal of Anesthesiology
Clinical Information

Uso do bloqueio combinado raqui-peridural durante cirurgia de cólon em paciente de alto risco: relato de caso

Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report

Luiz Eduardo Imbelloni; Marcos Fornasari; José Carlos Fialho

Downloads: 1
Views: 1028

Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado raqui-peridural (BCRP) oferece vantagens sobre a anestesia peridural ou subaracnóidea com injeção única. O objetivo deste relato foi apresentar um caso onde a anestesia subaracnóidea segmentar pode ser técnica efetiva para intervenção cirúrgica gastrintestinal com respiração espontânea. RELATO DO CASO: Paciente estado físico ASA III, diabetes mellitus tipo II, com hipertensão arterial sistêmica e doença pulmonar obstrutiva crônica, foi escalada para ressecção de tumor de cólon direito. O BCRP foi realizado no interespaço T5 - T6 e foram injetados 8 mg de bupivacaína a 0,5% isobárica acrescida de 50 µg de morfina no espaço subaracnóideo. O cateter peridural (20G) foi introduzido quatro centímetros em direção cefálica. Foi obtida sedação com doses fracionadas de 1 mg de midazolam (total de 6 mg). Bupivacaína a 0,5% foi administrada em bolus de 25 mg através do cateter duas horas após a anestesia subaracnóidea. Não houve necessidade de vasopressor nem atropina. CONCLUSÕES: Este caso proporciona evidências de que a raquianestesia segmentar pode ser uma técnica anestésica para operação gastrintestinal com respiração espontânea.

Palavras-chave

CIRURGIA, Abdominal, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Combined spinal epidural anesthesia (CSEA) has advantages over single injection epidural or subarachnoid blockades. The objective of this report was to present a case in which segmental subarachnoid block can be an effective technique for gastrointestinal surgery with spontaneous respiration. CASE REPORT: Patient with physical status ASA III, with diabetes mellitus type II, hypertension, and chronic obstructive pulmonary disease was scheduled for resection of a right colon tumor. Combined spinal epidural block was performed in the T5-T6 space and 8 mg of 0.5% isobaric bupivacaine with 50 µg of morphine were injected in the subarachnoid space. The epidural catheter (20G) was introduced four centimeters in the cephalad direction. Sedation was achieved with fractionated doses of 1 mg of midazolam (total of 6 mg). A bolus of 25 mg of 0.5% bupivacaine was administered through the catheter two hours after the subarachnoid block. Vasopressors and atropine were not used. CONCLUSIONS: This case provides evidence that segmental spinal block can be the anesthetic technique used in gastrointestinal surgeries with spontaneous respiration.

Keywords

ANESTHETIC TECHNIQUES, Regional, SURGERY, Abdominal

References

Soresi AL. Episubdural anesthesia. Anesth Analg. 1937;16:306-310.

Frumin MJ, Schwartz H, Burns J. Dorsal root ganglion blockade during threshold segmental spinal anesthesia in man. J Pharm Exp Ther. 1954;112:387-392.

van Zundert AAJ, Stultiens G, Jakimowicz JJ. Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study. Br J Anaesth. 2007;98:682-686.

Imbelloni LE, Ferraz Filho JR, Quirici MB. Magnetic resonance imaging of the spine column. Br J Anaesth. 2008;101:433-434.

Krommendijk EJ, Verheinjen R, van Dijk B. The PENCAN 25gauge needle: a new pencil-point for spinal anesthesia tested in 1,193 patients. Reg Anesth Pain Med. 1999;24:43-50.

Groeben H, Schäfer B, Pavlakovic G. Lung function under high thoracic segmental epidural anesthesia with ropivacaine or bupivacaine in patients with severe obstructive pulmonary disease undergoing breast surgery. Anesthesiology. 2002;93:536-541.

Eikermann M, Blobner M, Groeben H. Postoperative upper airway obstruction after recovery of the train of four ratio of the adductor pollicis muscle from neuromuscular blockade. Anesth Analg. 2006;102:937-942.

Licker M, Schweizer A, Ellenberger C. Perioperative medical management of patients with COPD. Int J Chron Pulmon Dis. 2007;2:493-515.

Butterworth J. Physiology of spinal anesthesia: what are the implications for management?. Reg Anesth Pain Med. 1998;23:370-373.

Stevens RA, Frey K, Liu SS. Sympathetic block during spinal anesthesia in volunteers using lidocaine, tetracaine, and bupivacaine. Reg Anesth. 1997;22:325-331.

Kapala M, Meterissian S, Schricker T. Neuraxial anesthesia and intraoperative bilevel positive airway pressure in a patient with severe chronic obstructive pulmonary disease and obstructive sleep apnea undergoing elective sigmoid resection. Reg Anesth Pain Med. 2009;34:69-71.

5dd5921b0e8825cf63c8fca6 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections