Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000400008
Brazilian Journal of Anesthesiology
Clinical Information

Lesão da artéria ilíaca esquerda durante laminectomia lombar: relato de caso

Left iliac artery injury during lumbar laminectomy: case report

Wanderley Rodrigues Moreira; Hélio Humberto Cançado Xavier

http://dx.doi.org/10.1590/S0034-70942003000400008 Braz J Anesthesiol, vol.53, n4, p.489-495, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: Lesão da artéria ilíaca é uma ocorrência rara em laminectomias, porém, muito grave. O objetivo deste relato é apresentar um caso de lesão da artéria ilíaca esquerda, em paciente submetido a laminectomia lombar sob raquianestesia, que se manifestou clinicamente no pós-operatório imediato, sete horas após o início da cirurgia. RELATO DO CASO: Paciente do sexo masculino, estado físico ASA I, 31 anos, 68 kg, foi submetido à laminectomia lombar em decúbito ventral sob raquianestesia em L2-L3, com bupivacaína hiperbárica a 0,5% (20 mg) e fentanil 25 µg. A cirurgia transcorreu normalmente e sete horas após o seu início, já no pós-operatório, o paciente apresentou hipotensão arterial, taquicardia, agitação e dor abdominal difusa. A tomografia abdominal mostrou aspecto compatível com hematoma retroperitoneal e a laparotomia exploradora revelou lesão da artéria ilíaca comum esquerda. Após a laparotomia, o paciente evoluiu bem. CONCLUSÕES: Na dependência do posicionamento e do estado físico, técnicas de anestesia geral se impõem. O caso chama atenção para o fato de que qualquer técnica anestésica que tenha sido realizada, o sangramento no campo operatório pode não ser real, na vigência de uma lesão vascular, porque este sangramento pode ser tardio. No presente caso, a manifestação clínica ocorreu sete horas após o início da cirurgia, quando o paciente já estava recuperado da anestesia. No entanto, o fenômeno (hipotensão arterial) poderia ter ocorrido no per-operatório.

Palavras-chave

CIRURGIA, CIRURGIA, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Iliac artery injury during laminectomy is an uncommon, however very serious event. This report aimed at presenting a case of left iliac artery injury in patient submitted to lumbar laminectomy under spinal anesthesia, that was clinically manifested in the immediate postoperative period, seven hours after beginning of surgery. CASE REPORT: Male patient, physical status ASA I, 31 years old, 68 kg, submitted to lumbar laminectomy in prone position under spinal anesthesia in L2-L3 interspace with 20 mg 0.5% hyperbaric bupivacaine and 25 µg fentanyl. Surgery went on normally and seven hours after its beginning, already in the postoperative period, patient presented arterial hypotension, tachycardia, agitation and diffuse abdominal pain. An abdominal CT-scan showed extensive retroperitoneal hematoma and exploratory laparotomy revealed left iliac artery injury. After laparotomy, patient recovered without intercurrences. CONCLUSIONS: General anesthesia is mandatory depending on patients’ positioning and physical status. This case calls the attention to the fact that regardless of the anesthetic technique, there might be no operative field bleeding in the presence of vascular injury because this bleeding may be late. In our case, clinical manifestation was seven hours after beginning of surgery, when the patient had already recovered from anesthesia. However, the event (arterial hypotension) could have happened in the intraoperative period.

Keywords

ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, COMPLICATIONS, SURGERY, SURGERY

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