Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2018.02.007
Brazilian Journal of Anesthesiology
Clinical Information

Livedo reticularis by hypothermia during anesthesia for dental treatment in Down's syndrome patient

Livedo reticular por hipotermia durante anestesia para tratamento odontológico em paciente com síndrome de Down

Heber de Moraes Penna; Norma Sueli Pinheiro Modolo; Dário Humberto de Paiva

Downloads: 0
Views: 53

Abstract

Abstract Background: Livedo reticularis is a benign dermatological condition characterized by ischemic areas permeated by erythematous-cyanotic areas in a lacy pattern, and may be transient or permanent and is frequently associated with body exposure to cold. Cutaneous arterial vasospasm promotes ischemia, and venous dilation of the congested areas occurs by tissue hypoxia or autonomic dysfunction. Patients with Down's syndrome, due to their physiological peculiarities, constitute a representative part of those who require dental care under general anesthesia, and livedo reticularis has a reported incidence of 8-12% in Down's syndrome patients. Objectives: To describe the physiological livedo reticularis in a Down's syndrome patient, with the onset during the anesthetic-surgical procedure. Case report: 5-year-old female patient with Down's syndrome, admitted for dental treatment under balanced general anesthesia with sevoflurane, fentanyl, and atracurium. Transoperative hypothermia occurred with axillary temperature reaching 34.5 °C after 30 min after the beginning of anesthesia. At the end of the procedure, red-purplish skin lesions interspersed with areas of pallor were observed exclusively on the ventromedial aspect of the right forearm, with no systemic signs suggestive of allergic reactions. The established diagnosis was physiological livedo reticularis. There was a total fading of the lesions within 5 days. Conclusion: This report evidences the need for thermal control of patients undergoing anesthesia, as well as the manifestation of livedo reticularis as a consequence of transoperative hypothermia.

Keywords

Down's syndrome, Trisomy 21, Anesthesia, Livedo reticularis, Hypothermia, Dental treatment

Resumo

Resumo Justificativa: O livedo reticular representa quadro dermatológico benigno, caracterizado por áreas isquêmicas permeadas por áreas eritematocianóticas em padrão rendilhado, pode ser transitório ou permanente e frequentemente é associado à exposição corporal ao frio. O vasoespasmo arterial cutâneo promove a isquemia e a dilatação venosa das áreas congestas e ocorre por hipóxia tecidual ou por disfunção autonômica. Os portadores da síndrome de Down, devido às suas peculiaridades fisiológicas, constituem uma representativa parcela daqueles que necessitam de atendimento odontológico sob anestesia geral e o livedo reticular tem incidência relatada de 8% a 12% em pacientes com síndrome de Down. Objetivos: Descrever quadro de livedo reticular fisiológico em paciente portador de síndrome de Down, com aparecimento durante o ato anestésico-cirúrgico. Relato do caso: Paciente de cinco anos, sexo feminino, síndrome de Down, admitida para tratamento odontológico sob anestesia geral balanceada, com emprego de sevoflurano, fentanil e atracúrio. Houve ocorrência de hipotermia transoperatória, a temperatura axilar atingiu 34,5 ºC após 30 minutos do início da anestesia. Ao término do procedimento, notaram-se lesões cutâneas vermelho-arroxeadas, intercaladas com áreas de palidez, exclusivamente na face ventromedial do antebraço direito, sem sinais sistêmicos sugestivos de reações alérgicas. O diagnóstico firmado foi de livedo reticular fisiológico. Houve esmaecimento total das lesões em cinco dias. Conclusão: O relato apresentado evidencia a necessidade de controle térmico de pacientes submetidos a anestesias, bem como registra manifestação de livedo reticular em consequência de hipotermia transoperatória.

Palavras-chave

Síndrome de Down, Trissomia do 21, Anestesia, Livedo reticular, Hipotermia, Tratamento odontológico

References

Criado PR, Faillace C, Magalhães LS. Livedo reticular: classificação, causas e diagnósticos diferenciais. Acta Reumatol Port. 2012;37:218-25.

Sajjan VV, Lunge S, Swamy MB. Livedo reticularis: a review of the literature. Indian Dermatol Online J. 2015;6:315-21.

Lewanda AF, Matisoff A, Revenis M. Preoperative evaluation and comprehensive risk assessment for children with Down syndrome. Pediatr Anesth. 2016;26:356-62.

Nirmala SVSG, Saikrishna D. Dental concerns of children with Down's syndrome – an overview. J Pediatr Neonatal Care. 2017;6:1-7.

Madan V, Williams J, Lear JT. Dermatological manifestations of Down's syndrome. Clin Exp Dermatol. 2006;31:623-9.

5dcafb880e8825b53903b87a rba Articles
Links & Downloads

Braz. J. Anesthesiol.

Share this page
Page Sections