Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000100009
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia para ventriculostomia por via endoscópica para tratamento de hidrocefalia: relato de casos

Anesthesia for endoscopic ventriculostomy for the treatment of hydrocephalus: case report

Friederike Wolff Valadares; Michelle Nacur Lorentz; Eliana G. Heyden; José Aloysio Costa Val Filho

http://dx.doi.org/10.1590/S0034-70942007000100009 Braz J Anesthesiol, vol.57, n1, p.83-89, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: A terceiro-ventriculostomia endoscópica está se tornando um procedimento de rotina entre as intervenções neurocirúrgicas infantis. Entretanto, relatos sobre anestesia para crianças submetidas a tais procedimentos ainda são escassos. O objetivo desta série de casos foi demonstrar os cuidados e a eficácia do método empregado. RELATO DOS CASOS: Foram avaliadas retrospectivamente 38 crianças abaixo de 2 anos que se submeteram à terceiro-ventriculostomia neuroendoscópica para tratamento de hidrocefalia obstrutiva no período de 1999 a 2004 no Biocor Instituto. Foram estudados o diagnóstico, comorbidades, idade, peso, técnica anestésica, monitorização e as complicações intra e pós-operatórias. Todos os pacientes, entre 1 semana e 20 meses, apresentavam hidrocefalia obstrutiva por compressão do aqueduto de etiologia variada. A indução anestésica em 35 crianças foi por via inalatória e por via venosa em três delas. A monitorização de 34 pacientes foi com eletrocardiograma, oxímetro de pulso, capnógrafo e termômetro esofágico, sendo quatro crianças monitorizadas com pressão arterial invasiva contínua. A manutenção da anestesia em 15 pacientes foi balanceada com fentanil e isoflurano e em outros 23 pacientes inalatória com isoflurano. Trinta e cinco crianças foram extubadas após o procedimento na sala cirúrgica e outras três no CTI. Seis pacientes foram encaminhados ao CTI após a extubação. Complicações observadas: disritmias cardíacas sem repercussão hemodinâmica no intra-operatório (seis casos). Dois pacientes tiveram sangramento intra-operatório, mas somente um deles demandou implante de derivação ventricular externa. As complicações no pós-operatório foram: vômitos (6), picos febris (4) convulsões (2), laringoespasmo (1) e estridor laríngeo (1). CONCLUSÕES: A terceiro-ventriculostomia apresenta baixa incidência de complicações mesmo em pacientes com menos de 24 meses, desde que sejam adotadas técnicas anestésicas e cirúrgicas adequadas.

Palavras-chave

ANESTESIA, Pediátrica, CIRURGIA, Neurocirurgia, Doenças, Congênita

Abstract

BACKGROUND AND OBJECTIVES: Endoscopic third ventriculostomy is becoming routine among neurosurgical pediatric procedures. However, reports on anesthesia for children undergoing such procedures are rare. The aim of this series of cases was to demonstrate the precautions that should be taken and efficacy of the method used. CASE REPORT: Thirty-eight children younger than 2 years, who underwent neuroendoscopic third ventriculostomy for the treatment of obstructive hydrocephalus from 1999 to 2004 at the Biocor Instituto were evaluated retrospectively. The diagnosis, comorbidities, age, weight, anesthetic technique, monitoring, and intra- and postoperative complications were evaluated. Patients, ages 1 week to 20 months, presented obstructive hydrocephalus secondary to compression of the aqueduct of different etiologies. In thirty-five children anesthesia was induced by inhalational anesthetics and in 3 by intravenous anesthetics. Thirty-four patients were monitored with electrocardiogram, pulse oxymeter, capnograph, and esophageal thermometer, while in 4 children it included also continuous invasive blood pressure monitoring. Fifteen patients had balanced maintenance anesthesia with fentanyl and isoflurane, and 23 children received inhalational isoflurane. Thirty-five children were extubated after the procedure in the surgical room and three in the ICU. Six patients were transferred to the ICU after extubation. The following complications were observed: intraoperative cardiac arrhythmias without hemodynamic repercussions (6 cases); two patients presented intraoperative bleeding, but in only one the placement of an external derivation was necessary. The postoperative complications included: vomiting (6), fever (4), seizures (2), laryngeal spasm (1), and stridor (1). CONCLUSIONS: Third ventriculostomy has a low incidence of complications, even in patients younger than 24 months, as long as proper anesthetic and surgical procedures are used.

Keywords

ANESTHESIA, Pediatric, DISEASES, congenital, SURGERY, Neurosurgery

References

Gorayeb RP, Cavalheiro S, Zymberg ST. Endoscopic third ventriculostomy in children younger than 1 year of age. J Neurosurg. 2004;100(^s5):427-429.

Fritsch MJ, Kienke S, Ankermann T. Endoscopic third ventriculostomy in infants. J Neurosurg. 2005;103(^s1):50-53.

Warf BC. Hydrocephalus in Uganda: the predominance of infectious origin and primary management with endoscopic third ventriculostomy. J Neurosurg. 2005;102(^s1):1-15.

Sarrow AM, Cohen AR. Neuroendoscopy. Principles and Practice of Pediatric Neurosurgery. 1999:91-105.

Johnson J, Jimenez DF, Tobias JD. Anaesthetic care during minimally invasive neurosurgical procedures in infants and children. Pediatr Anaesth. 2002;12:478-488.

Baykan N, Isbir O, Gercek A. Ten years of experience with pediatric neuroendoscopic third ventriculostomy: features and perioperative complications of 210 cases. J Neurosurg Anesthesiol. 2005;17:33-37.

Gangemi M, Donati P, Maiuri F. Endoscopic third ventriculostomy for hydrocephalus. Minim Invasive Neurosurgery. 1999;42:128-132.

Ambesh SP, Kumar R. Neuroendoscopic procedures: anesthetic considerations for a growing trend: a review. J Neurosurg Anesthesiol. 2000;12:262-270.

van Aken J, Struys M, Verplancke T. Cardiovascular changes during endoscopic third ventriculostomy. Minim Invasive Neurosurg. 2003;46:198-201.

El-Dawlatly AA, Murshid WR, Elshimy A. The incidence of bradycardia during endoscopic third ventriculostomy. Anesth Analg. 2000;91:1142-1144.

Fabregas N, Lopez A, Valero R. Anesthetic management of surgical neuroendoscopies: usefulness of monitoring the pressure inside the neuroendoscope. J Neurosurg Anesthesiol. 2000;12:21-28.

Anandh B, Madhusudan Reddy KR, Mohanty A. Intraoperative bradycardia and postoperative hyperkalemia in patients undergoing endoscopic third ventriculostomy. Minim Invasive Neurosurg. 2002;45:154-157.

Handler MH, Abbott R, Lee M. A near-fatal complication of endocopic third ventriculostomy: case report. Neurosurgery. 1994;35:525-528.

Saxena S, Ambesh SP, Saxena HN. Pneumoencephalus and convulsions after ventriculoscopy: a potentially catastrophic complication. J Neurosurg Anesthesiol. 1999;11:200-202.

Schroeder HW, Warzok RW, Assaf JA. Fatal subarachnoid hemorrhage after endoscopic third ventriculostomy: Case report. J Neurosurg. ;1999(90):153-155.

El-Dawlatly AA. Endoscopic third ventriculostomy: anesthetic implications. Minim Invasive Neurosurg. 2004;47:151-153.

Schroeder HW, Niendorf WR, Gaab MR. Complications of endoscopic third ventriculoscopy. J Neurosurg. 2002;96:032-1040.

El-Dawlatly AA, Murshid W, Alshimy A. Arrhythmias during neuroendoscopic procedures. J Neurosurg Anesthesiol. 2001;13:57-58.

Hepner DL, Castells M. Latex allergy: an update. Anesth Analg. 2003;96:1219-1229.

Holzman RS. Clinical management of latex-allergic children. Anesth Analg. 1997;85:529-533.

Allarcon JB, Malito M, Linder H. Alergia ao látex. Rev Bras Anestesiol. 2003;53:89-96.

Kleinmann SE, Bissonnette B. Management of successful pediatric neuroanesthesia. Anesthesiol Clin North America. 1992;10:537-561.

Hamid RK, Newfield P. Pediatric neuroanesthesia: Neural tube defects. Anesthesiol Clin North America. 2001;19:219-228.

Newfield P, Hamid RKA. Anesthesia for Pediatric Neurosurgery. Anesthesia and Neurosurgery. 2001:501-530.

Bracco D, Bissonnette B. Neurosurgery and Neurotraumatology: Anesthetic Considerations and Postoperative Management. Pediatric Anesthesia. 2002:1120-1153.

Westman Hr, Davis PJ. Anesthesia for Neurosurgery. Principles and Practice of Pediatric Neurosurgery. 1999:1249-1274.

Furst SR, Sullivan LJ, Soriano S. Effects of ondansetron on emesis in the first 24 hours after craniotomy in children. Anesth Analg. 1996;83:325-328.

Cote CJ, Zaslavsky A, Downes JJ. Postoperative apnea in former preterm infants after inguinal herniorrhaphy: A combined analysis. Anesthesiology. 1995;82:809-822.

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