Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000600008
Brazilian Journal of Anesthesiology
Clinical Information

Tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção acidental da duramáter em paciente HIV positivo: relato de caso

Epidural patch with dextran 40 to prevent postdural puncture headache in an HIV patient: case report

Marcos Guilherme Cunha Cruvinel; Paulo Roberto Vieira Barbosa; Vera Coelho Teixeira; Carlos Henrique Viana de Castro

http://dx.doi.org/10.1590/S0034-70942002000600008 Braz J Anesthesiol, vol.52, n6, p.712-718, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção de duramáter é uma complicação bem conhecida das anestesias subaracnóideas e peridurais, sendo o tampão sangüíneo considerado o tratamento mais eficaz, até o momento. Este é um procedimento invasivo e sujeito a complicações graves. Seu uso em certos pacientes, como portadores de HIV ou leucemias, é motivo de debate. Várias alternativas têm sido relatadas. O objetivo deste artigo é apresentar um caso do uso do tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção de duramáter em paciente portador do vírus da imunodeficiência humana (HIV), com história de cefaléia em anestesia subaracnóidea anterior. RELATO DE CASO: Paciente masculino, 31 anos, 70 kg, estado físico ASA II, portador de HIV, para tratamento de condilomatose anal recidivada, com relato de cefaléia intensa e limitante durante duas semanas após anestesia subaracnóidea (agulha Quincke 25G). Durante tentativa de anestesia peridural com agulha de Tuohy 18G em L3-L4, houve perfuração acidental da duramáter. Foram injetados, por duas vezes, 20 ml de dextran 40 a 10% por cateter peridural; a primeira, 150 minutos após a administração dos anestésicos e a segunda na manhã seguinte à cirurgia. O paciente evoluiu assintomático e recebeu alta no dia seguinte à sua internação. CONCLUSÕES: O uso do tampão com soluções colóides como o dextran 40 não está bem estabelecido, porém existem alguns relatos do seu uso com sucesso e entendemos que seu potencial deva ser melhor explorado.

Palavras-chave

COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Postdural puncture headache is a well-known complication of spinal and epidural anesthesia and, so far, its most effective treatment is the epidural blood patch. Nevertheless this is an invasive procedure subject to severe complications. Its use in special patient populations (HIV positive patients and leukemias) is controversial. Several alternatives have been reported. This study aimed at showing a case of prophylactic epidural dextran 40 patch in an HIV patient with previous history of headache following spinal anesthesia. CASE REPORT: Male patient, 31 years old, 70 kg, physical status ASA II, HIV positive, presented for recurrent anal condylomatosis treatment, with a history of severe and limiting headache for two weeks following spinal anesthesia. (25G Quincke needle). During an L3-L4 epidural puncture attempt with an 18G Tuohy needle there was an accidental dural puncture. Twenty milliliters of 10% dextran 40 were administered twice through an epidural catheter. First, 150 minutes after anesthesia and then in the morning following surgery. Patient had no headache complaint and was discharged on the following day. CONCLUSIONS: The use of a patch with colloid solutions, such as dextran 40, is not well established, but there are some successful reports and it is our understanding that its potential should be further investigated.

Keywords

ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, COMPLICATIONS

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