Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000600010
Brazilian Journal of Anesthesiology
Clinical Information

Uso da abordagem lateral para introdução de máscara laríngea durante craniotomia em paciente acordado: relato de caso

Use of the lateral approach for laryngeal mask insertion during awake craniotomy: case report

Mirna Bastos Marques; Carlos Henrique Vianna de Castro; Dener Augusto Diniz; Ana Tereza Moreira Dantas de Andrade Pinto; Marcello Penholate Faria

http://dx.doi.org/10.1590/S0034-70942006000600010 Braz J Anesthesiol, vol.56, n6, p.654-657, 2006
PDF Português
PDF English
Downloads: 0
Views: 951

Resumo

JUSTIFICATIVA E OBJETIVOS: Durante uma craniotomia em que se realiza o teste de Afasia de Aachen com o paciente acordado e cooperativo, é necessário o uso da técnica anestésica "dormindo-acordado-dormindo". O objetivo deste relato de caso foi descrever a técnica anestésica utilizada em paciente com sinais de via aérea difícil. RELATO DO CASO: Descreveu-se o caso de um paciente submetido à ressecção de um tumor no lobo temporal esquerdo, no giro de Wernicke, com sinais clínicos de via aérea difícil. Foi utilizada a técnica "dormindo-acordado-dormindo", com infusão contínua de propofol e remifentanil. A via aérea foi mantida com o uso da máscara laríngea, por abordagem lateral. CONCLUSÕES: A técnica utilizada foi eficaz para a obtenção de um paciente acordado e cooperativo no intra-operatório, tendo sido assegurada permeabilidade da via aérea com o uso da máscara laríngea. A inserção desse dispositivo por abordagem lateral é de especial interesse por se tratar de um paciente com possível dificuldade de acesso à via aérea, em procedimento cirúrgico em que era necessário evitar deslocamento do paciente e contaminação do campo cirúrgico.

Palavras-chave

ANESTÉSICOS, Venoso, ANESTÉSICOS, Venoso, ANESTÉSICOS, Venoso, ANESTÉSICOS, Venoso, CIRURGIA, Neurocirurgia, EQUIPAMENTOS, Máscara laríngea

Abstract

BACKGROUND AND OBJECTIVES: During an awake craniotomy in which the Aachen Aphasia test is performed, it is necessary to use the "asleep-awake-asleep" anesthetic technique. The objective of this case report was to describe the anesthetic technique used in a patient with signs of difficult airway. CASE REPORT: The case of a patient who underwent resection of a tumor in the left temporal lobe, in the Wernicke gyrus, with clinical signs of difficult airway is reported. The "asleep-awake-asleep" anesthetic technique, with continuous infusion of propofol and remifentanil, was used. A laryngeal mask, inserted by the lateral approach, was used to keep the airways patency. CONCLUSIONS: The technique used was effective in obtaining an intraoperative awake and cooperative patient, and the airways were maintained patent with a laryngeal mask. Insertion of this device by the lateral approach is especially interesting since this was a patient who presented difficult airway and underwent a surgical procedure in which in which the patient must remain immobile and the surgical field cannot be contaminated.

Keywords

ANESTHETICHS, Intravenous, ANESTHETICHS, Intravenous, ANESTHETICHS, Intravenous, ANESTHETICHS, Intravenous, EQUIPMENT, SURGERY, Neurosurgery

References

Vinas FC, Zamorano L, Mueller RA. [150] PET and intraoperative brain mapping: a comparison in the localization of eloquent cortex. Neurol Res. 1997;19:601-608.

Huber W, Poeck K, Willmes K. The Aachen Aphasia Test. Adv Neurol. 1984;42:291-303.

Reulen HJ, Schmid UD, Ilmberger J. Tumor surgery of the speech cortex in local anesthesia. Neuropsychological and neurophysiological monitoring during operations in the dominant hemisphere. Nervenarzt. 1997;68:813-24.

Huncke K, Van de Wiele B, Fried I. The asleep-awake-asleep anesthetic technique for intraoperative language mapping. Neurosurgery. 1998;42:1312-1317.

Johnson KB, Egan TD. Remifentanil and propofol combination for awake craniotomy: case report with pharmacokinetic stimulation. . 1998;10:25-29.

Hans P, Bonhomme V, Born JD. Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy. Anaesthesia. 2000;55:255-259.

Keifer JC, Dentchev D, Little K. A retrospective analysis of a remifentanil/propofol general anesthetic for craniotomy before awake functional brain mapping. Anesth Analg. 2005;101:502-508.

Ard JL Jr, Bekker AY, Doyle WK. Dexmedetomidine in awake craniotomy: a technical note. Surg Neurol. 2005;63:114-117.

Ard J, Doyle W, Bekker A. Awake craniotomy with dexmedetomidine in pediatric patients. J Neurosurg Anaesthesiol. 2003;15:263-266.

Bekker AY, Kaufman B, Samir H. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg. 2001;92:1251-1253.

Mack PF, Perrine K, Kobylarz E. Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol. 2004;16:20-25.

Bekker AY, Basile J, Gold M. Dexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects. J Neurosurg Anesthesiol. 2004;16:126-135.

Audu PB, Wilkerson C, Bartkowski R. Plasma ropivacaine levels during awake intracranial surgery. J Neurosurg Anesthesiol. 2005;17:153-155.

Costello TG, Cormack JR, Hoy C. Plasma ropivacaine levels following scalp block for awake craniotomy. J Neurosurg Anesthesiol. 2004;16:147-150.

Taylor S, Berry A. Thumb insertion technique for resuscitation using the laryngeal mask airway. Emerg Med. 1998;10:78.

Brimacombe JR. Laryngeal Mask Anesthesia: Principles and Practices. 2005.

5dd2fdee0e88250f06c63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections