Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.03.013
Brazilian Journal of Anesthesiology
Clinical Informations

Anesthetic management of a patient with multiple sclerosis - case report

Controle anestésico de paciente com esclerose múltipla - relato de caso

Eduardo Barbin Zuccolotto; Guilherme Coelho Machado Nunes; Rafael Soares Lopes Nogueira; Eugenio Pagnussatt Neto; José Roberto Nociti

http://dx.doi.org/10.1016/j.bjane.2014.03.013 Braz J Anesthesiol, vol.66, n4, p.414-417, 2016
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Abstract

Abstract Background and objectives: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. Case report: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy. Balanced general anesthesia was chosen, with midazolam, propofol and remifentanil target-controlled infusion; sevoflurane via laryngeal mask airway; and spontaneous ventilation. Because the patient had respiratory difficulty presenting with chest wall rigidity, it was decided to discontinue the infusion of remifentanil. There was no other complication or exacerbation of disease postoperatively. Conclusion: The use of neuromuscular blockers (depolarizing and non-depolarizing) is a problem in these patients. As there was no need for muscle relaxation in this case, muscle relaxants were omitted. We conclude that the combination of propofol and sevoflurane was satisfactory, not resulting in hemodynamic instability or disease exacerbation.

Keywords

Multiple sclerosis, Urologic surgery, Propofol, Sevoflurane, Remifentanil

Resumo

Resumo Justificativa e objetivos: Esclerose múltipla é doença desmielinizante do cérebro e da medula espinhal, caracterizada por fraqueza muscular, disfunção cognitiva, perda da memória, alterações de personalidade. Fatores que promovem exacerbação da doença são estresse, trauma físico, infecções, cirurgias, hipertermia. O objetivo é descrever a abordagem anestésica de um caso encaminhado a cirurgia urológica. Relato de caso: Paciente do sexo feminino, 44 anos, portadora de esclerose múltipla, com o diagnóstico de nefrolitíase, é encaminhada a ureterolitotripsia endoscópica. Optou-se por anestesia geral balanceada com midazolam, propofol e remifentanil em infusão alvo-controlada, sevoflurano sob máscara laríngea e ventilação espontânea. Tendo apresentado dificuldade ventilatória por tórax rígido, optou-se por interromper a infusão de remifentanil. Não se registraram outras intercorrências nem exacerbação da doença no pós-operatório. Conclusão: O uso de bloqueadores neuromusculares (tanto despolarizantes como não-despolarizantes) constitui um problema nestes pacientes. Como não havia necessidade de relaxamento muscular neste caso, eles foram omitidos. Concluímos que a associação de propofol e sevoflurano foi satisfatória, não resultando em instabilidade hemodinâmica nem exacerbação da doença.

Palavras-chave

Esclerose múltipla, Cirurgia urológica, Propofol, Sevoflurano, Remifentanil

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